Association of baseline diaphragm, rectus femoris and vastus intermedius muscle thickness with weaning from mechanical ventilation
To determine whether baseline diaphragm (Tdi), rectus femoris (RF) and vastus intermedius (VI) muscle thickness (TRF and TRF + VI) are associated with weaning success. Right Tdi, TRF and TRF + VI were measured by ultrasonography within 36 h of intubation and diaphragmatic excursion (DE) was evaluate...
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| Veröffentlicht in: | Respiratory medicine 2021-08, Vol.185, p.106503-106503, Article 106503 |
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| creator | Er, Berrin Simsek, Meltem Yildirim, Mehmet Halacli, Burcin Ocal, Serpil Ersoy, Ebru Ortac Demir, Ahmet Ugur Topeli, Arzu |
| description | To determine whether baseline diaphragm (Tdi), rectus femoris (RF) and vastus intermedius (VI) muscle thickness (TRF and TRF + VI) are associated with weaning success.
Right Tdi, TRF and TRF + VI were measured by ultrasonography within 36 h of intubation and diaphragmatic excursion (DE) was evaluated at the first spontaneous breathing trial in adult critically-ill patients. Reintubation or death within 7 days after extubation was defined as weaning failure. Weaning failure and success groups were compared in terms of ultrasonographic measurements and clinical features.
Thirty-eight patients were assessed for weaning, 15 (39.4%) being in the weaning failure group. The median body mass index (BMI) was lower while the median clinical frailty scale (CFS), vasopressor use, duration of mechanical ventilation, intensive care and hospital mortality rate were higher in the weaning failure group, and the median TRF + VI (14.0 [12.3–26.2] vs 23.6 [21.3–27.1] mm, p = 0.03) and median DE (19.4 [14.6–24.0] vs 25.9 [19.3–38.5] mm, p = 0.045) were lower. The median Tdi was similar in two groups (1.9 [1.5–2.3] vs 2.0 [1.7–2.4] mm, p = 0.26). In ROC analysis, area under the curve for TRF + VI was 0.71 (95% CI: 0.51–0.90; p = 0.035), with 21 mm cut-off having sensitivity of 82% and specificity of 57%. Binary logistic regression analysis revealed TRF + VI |
| doi_str_mv | 10.1016/j.rmed.2021.106503 |
| format | Article |
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Right Tdi, TRF and TRF + VI were measured by ultrasonography within 36 h of intubation and diaphragmatic excursion (DE) was evaluated at the first spontaneous breathing trial in adult critically-ill patients. Reintubation or death within 7 days after extubation was defined as weaning failure. Weaning failure and success groups were compared in terms of ultrasonographic measurements and clinical features.
Thirty-eight patients were assessed for weaning, 15 (39.4%) being in the weaning failure group. The median body mass index (BMI) was lower while the median clinical frailty scale (CFS), vasopressor use, duration of mechanical ventilation, intensive care and hospital mortality rate were higher in the weaning failure group, and the median TRF + VI (14.0 [12.3–26.2] vs 23.6 [21.3–27.1] mm, p = 0.03) and median DE (19.4 [14.6–24.0] vs 25.9 [19.3–38.5] mm, p = 0.045) were lower. The median Tdi was similar in two groups (1.9 [1.5–2.3] vs 2.0 [1.7–2.4] mm, p = 0.26). In ROC analysis, area under the curve for TRF + VI was 0.71 (95% CI: 0.51–0.90; p = 0.035), with 21 mm cut-off having sensitivity of 82% and specificity of 57%. Binary logistic regression analysis revealed TRF + VI < 21 mm as the only predictor of weaning failure with an odds ratio of 10.5 (95% CI: 1.1–97.8, p = 0.038) after adjusting for age, sex, BMI and CFS.
TRF + VI lower than 21 mm, measured by ultrasonography within 36 h of intubation, was associated with weaning failure among critically-ill patients.
•Weaning failure is associated with increased morbidity and mortality.•Predicting the patients who will experience weaning failure can facilitate to direct limited resources properly.•Thickness of rectus femoris and vastus intermedius lower than 21 mm measured by ultrasound predicted weaning failure better than other variables.</description><identifier>ISSN: 0954-6111</identifier><identifier>EISSN: 1532-3064</identifier><identifier>DOI: 10.1016/j.rmed.2021.106503</identifier><identifier>PMID: 34166958</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Aged, 80 and over ; Body Mass Index ; Critical Care ; Critical Illness ; Diaphragm - diagnostic imaging ; Diaphragm - pathology ; Female ; Frailty ; Hospital Mortality ; Humans ; Intensive care ; Liberation from mechanical ventilation ; Logistic Models ; Male ; Middle Aged ; Quadriceps femoris ; Quadriceps Muscle - diagnostic imaging ; Quadriceps Muscle - pathology ; Respiratory failure ; Respiratory Insufficiency - diagnostic imaging ; Respiratory Insufficiency - pathology ; Respiratory Insufficiency - therapy ; ROC Curve ; Time Factors ; Ultrasonography ; Ultrasound ; Ventilator Weaning - adverse effects</subject><ispartof>Respiratory medicine, 2021-08, Vol.185, p.106503-106503, Article 106503</ispartof><rights>2021 Elsevier Ltd</rights><rights>Copyright © 2021 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-36af413b43738c678dab38b700c36d5467d5a72f06ffb8547067a7b5fb1909e83</citedby><cites>FETCH-LOGICAL-c400t-36af413b43738c678dab38b700c36d5467d5a72f06ffb8547067a7b5fb1909e83</cites><orcidid>0000-0002-7216-7438 ; 0000-0002-2256-3619 ; 0000-0003-4803-6224</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.rmed.2021.106503$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34166958$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Er, Berrin</creatorcontrib><creatorcontrib>Simsek, Meltem</creatorcontrib><creatorcontrib>Yildirim, Mehmet</creatorcontrib><creatorcontrib>Halacli, Burcin</creatorcontrib><creatorcontrib>Ocal, Serpil</creatorcontrib><creatorcontrib>Ersoy, Ebru Ortac</creatorcontrib><creatorcontrib>Demir, Ahmet Ugur</creatorcontrib><creatorcontrib>Topeli, Arzu</creatorcontrib><title>Association of baseline diaphragm, rectus femoris and vastus intermedius muscle thickness with weaning from mechanical ventilation</title><title>Respiratory medicine</title><addtitle>Respir Med</addtitle><description>To determine whether baseline diaphragm (Tdi), rectus femoris (RF) and vastus intermedius (VI) muscle thickness (TRF and TRF + VI) are associated with weaning success.
Right Tdi, TRF and TRF + VI were measured by ultrasonography within 36 h of intubation and diaphragmatic excursion (DE) was evaluated at the first spontaneous breathing trial in adult critically-ill patients. Reintubation or death within 7 days after extubation was defined as weaning failure. Weaning failure and success groups were compared in terms of ultrasonographic measurements and clinical features.
Thirty-eight patients were assessed for weaning, 15 (39.4%) being in the weaning failure group. The median body mass index (BMI) was lower while the median clinical frailty scale (CFS), vasopressor use, duration of mechanical ventilation, intensive care and hospital mortality rate were higher in the weaning failure group, and the median TRF + VI (14.0 [12.3–26.2] vs 23.6 [21.3–27.1] mm, p = 0.03) and median DE (19.4 [14.6–24.0] vs 25.9 [19.3–38.5] mm, p = 0.045) were lower. The median Tdi was similar in two groups (1.9 [1.5–2.3] vs 2.0 [1.7–2.4] mm, p = 0.26). In ROC analysis, area under the curve for TRF + VI was 0.71 (95% CI: 0.51–0.90; p = 0.035), with 21 mm cut-off having sensitivity of 82% and specificity of 57%. Binary logistic regression analysis revealed TRF + VI < 21 mm as the only predictor of weaning failure with an odds ratio of 10.5 (95% CI: 1.1–97.8, p = 0.038) after adjusting for age, sex, BMI and CFS.
TRF + VI lower than 21 mm, measured by ultrasonography within 36 h of intubation, was associated with weaning failure among critically-ill patients.
•Weaning failure is associated with increased morbidity and mortality.•Predicting the patients who will experience weaning failure can facilitate to direct limited resources properly.•Thickness of rectus femoris and vastus intermedius lower than 21 mm measured by ultrasound predicted weaning failure better than other variables.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Body Mass Index</subject><subject>Critical Care</subject><subject>Critical Illness</subject><subject>Diaphragm - diagnostic imaging</subject><subject>Diaphragm - pathology</subject><subject>Female</subject><subject>Frailty</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Liberation from mechanical ventilation</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Quadriceps femoris</subject><subject>Quadriceps Muscle - diagnostic imaging</subject><subject>Quadriceps Muscle - pathology</subject><subject>Respiratory failure</subject><subject>Respiratory Insufficiency - diagnostic imaging</subject><subject>Respiratory Insufficiency - pathology</subject><subject>Respiratory Insufficiency - therapy</subject><subject>ROC Curve</subject><subject>Time Factors</subject><subject>Ultrasonography</subject><subject>Ultrasound</subject><subject>Ventilator Weaning - adverse effects</subject><issn>0954-6111</issn><issn>1532-3064</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9v1DAQxS1ERbeFL8AB-ciBbMfxv0TiUlVQkCpxKWfLccZdL4m92MlWXPnkTdj2ysn285s3Mz9C3jPYMmDqar_NI_bbGmq2CEoCf0U2TPK64qDEa7KBVopKMcbOyUUpewBohYA35JwLplQrmw35e11KcsFOIUWaPO1swSFEpH2wh122D-MnmtFNc6Eex5RDoTb29GjLKoU44TpDWO7jXNyAdNoF9ytiKfQxTDv6iDaG-EB9TiMd0e2Wp7MDPWKcwvCv7Vty5u1Q8N3zeUl-fv1yf_Otuvtx-_3m-q5yAmCquLJeMN4JrnnjlG562_Gm0wCOq14KpXtpde1Bed81UmhQ2upO-o610GLDL8nHU-4hp98zlsmMoTgcBhsxzcXUUkgFXNewWOuT1eVUSkZvDjmMNv8xDMzK3uzNurdZ2ZsT-6Xow3P-3K1_LyUvsBfD55MBly2PAbMpLmB0C78VselT-F_-E9W9l7I</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>Er, Berrin</creator><creator>Simsek, Meltem</creator><creator>Yildirim, Mehmet</creator><creator>Halacli, Burcin</creator><creator>Ocal, Serpil</creator><creator>Ersoy, Ebru Ortac</creator><creator>Demir, Ahmet Ugur</creator><creator>Topeli, Arzu</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7216-7438</orcidid><orcidid>https://orcid.org/0000-0002-2256-3619</orcidid><orcidid>https://orcid.org/0000-0003-4803-6224</orcidid></search><sort><creationdate>202108</creationdate><title>Association of baseline diaphragm, rectus femoris and vastus intermedius muscle thickness with weaning from mechanical ventilation</title><author>Er, Berrin ; Simsek, Meltem ; Yildirim, Mehmet ; Halacli, Burcin ; Ocal, Serpil ; Ersoy, Ebru Ortac ; Demir, Ahmet Ugur ; Topeli, Arzu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-36af413b43738c678dab38b700c36d5467d5a72f06ffb8547067a7b5fb1909e83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Body Mass Index</topic><topic>Critical Care</topic><topic>Critical Illness</topic><topic>Diaphragm - diagnostic imaging</topic><topic>Diaphragm - pathology</topic><topic>Female</topic><topic>Frailty</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Liberation from mechanical ventilation</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Quadriceps femoris</topic><topic>Quadriceps Muscle - diagnostic imaging</topic><topic>Quadriceps Muscle - pathology</topic><topic>Respiratory failure</topic><topic>Respiratory Insufficiency - diagnostic imaging</topic><topic>Respiratory Insufficiency - pathology</topic><topic>Respiratory Insufficiency - therapy</topic><topic>ROC Curve</topic><topic>Time Factors</topic><topic>Ultrasonography</topic><topic>Ultrasound</topic><topic>Ventilator Weaning - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Er, Berrin</creatorcontrib><creatorcontrib>Simsek, Meltem</creatorcontrib><creatorcontrib>Yildirim, Mehmet</creatorcontrib><creatorcontrib>Halacli, Burcin</creatorcontrib><creatorcontrib>Ocal, Serpil</creatorcontrib><creatorcontrib>Ersoy, Ebru Ortac</creatorcontrib><creatorcontrib>Demir, Ahmet Ugur</creatorcontrib><creatorcontrib>Topeli, Arzu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Er, Berrin</au><au>Simsek, Meltem</au><au>Yildirim, Mehmet</au><au>Halacli, Burcin</au><au>Ocal, Serpil</au><au>Ersoy, Ebru Ortac</au><au>Demir, Ahmet Ugur</au><au>Topeli, Arzu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of baseline diaphragm, rectus femoris and vastus intermedius muscle thickness with weaning from mechanical ventilation</atitle><jtitle>Respiratory medicine</jtitle><addtitle>Respir Med</addtitle><date>2021-08</date><risdate>2021</risdate><volume>185</volume><spage>106503</spage><epage>106503</epage><pages>106503-106503</pages><artnum>106503</artnum><issn>0954-6111</issn><eissn>1532-3064</eissn><abstract>To determine whether baseline diaphragm (Tdi), rectus femoris (RF) and vastus intermedius (VI) muscle thickness (TRF and TRF + VI) are associated with weaning success.
Right Tdi, TRF and TRF + VI were measured by ultrasonography within 36 h of intubation and diaphragmatic excursion (DE) was evaluated at the first spontaneous breathing trial in adult critically-ill patients. Reintubation or death within 7 days after extubation was defined as weaning failure. Weaning failure and success groups were compared in terms of ultrasonographic measurements and clinical features.
Thirty-eight patients were assessed for weaning, 15 (39.4%) being in the weaning failure group. The median body mass index (BMI) was lower while the median clinical frailty scale (CFS), vasopressor use, duration of mechanical ventilation, intensive care and hospital mortality rate were higher in the weaning failure group, and the median TRF + VI (14.0 [12.3–26.2] vs 23.6 [21.3–27.1] mm, p = 0.03) and median DE (19.4 [14.6–24.0] vs 25.9 [19.3–38.5] mm, p = 0.045) were lower. The median Tdi was similar in two groups (1.9 [1.5–2.3] vs 2.0 [1.7–2.4] mm, p = 0.26). In ROC analysis, area under the curve for TRF + VI was 0.71 (95% CI: 0.51–0.90; p = 0.035), with 21 mm cut-off having sensitivity of 82% and specificity of 57%. Binary logistic regression analysis revealed TRF + VI < 21 mm as the only predictor of weaning failure with an odds ratio of 10.5 (95% CI: 1.1–97.8, p = 0.038) after adjusting for age, sex, BMI and CFS.
TRF + VI lower than 21 mm, measured by ultrasonography within 36 h of intubation, was associated with weaning failure among critically-ill patients.
•Weaning failure is associated with increased morbidity and mortality.•Predicting the patients who will experience weaning failure can facilitate to direct limited resources properly.•Thickness of rectus femoris and vastus intermedius lower than 21 mm measured by ultrasound predicted weaning failure better than other variables.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>34166958</pmid><doi>10.1016/j.rmed.2021.106503</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-7216-7438</orcidid><orcidid>https://orcid.org/0000-0002-2256-3619</orcidid><orcidid>https://orcid.org/0000-0003-4803-6224</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present); EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Aged, 80 and over Body Mass Index Critical Care Critical Illness Diaphragm - diagnostic imaging Diaphragm - pathology Female Frailty Hospital Mortality Humans Intensive care Liberation from mechanical ventilation Logistic Models Male Middle Aged Quadriceps femoris Quadriceps Muscle - diagnostic imaging Quadriceps Muscle - pathology Respiratory failure Respiratory Insufficiency - diagnostic imaging Respiratory Insufficiency - pathology Respiratory Insufficiency - therapy ROC Curve Time Factors Ultrasonography Ultrasound Ventilator Weaning - adverse effects |
| title | Association of baseline diaphragm, rectus femoris and vastus intermedius muscle thickness with weaning from mechanical ventilation |
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