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Diaphragmatic Kinetics Assessment by Tissue Doppler Imaging and Extubation Outcome.
Cammarota, Gianmaria; Boniolo, Ester; Santangelo, Erminio; De Vita, Nello; Verdina, Federico; Crudo, Samuele; Sguazzotti, Ilaria; Perucca, Raffaella; Messina, Antonio; Zanoni, Marta; Azzolina, Danila; Navalesi, Paolo; Longhini, Federico; Vetrugno, Luigi; Bignami, Elena; Della Corte, Francesco; Tarquini, Riccardo; De Robertis, Edoardo; Vaschetto, Rosanna.
Afiliação
  • Cammarota G; Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy. gmcamma@gmail.com.
  • Boniolo E; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
  • Santangelo E; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
  • De Vita N; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
  • Verdina F; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
  • Crudo S; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
  • Sguazzotti I; Anesthesia and General Intensive Care, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy.
  • Perucca R; Anesthesia and General Intensive Care, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy.
  • Messina A; Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.
  • Zanoni M; Anesthesia and General Intensive Care, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy.
  • Azzolina D; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
  • Navalesi P; Department of Medicine, University of Padua, Padua, Italy.
  • Longhini F; Department of Medical and Surgical Science, Università Magna Graecia, Catanzaro, Italy.
  • Vetrugno L; Department of Medicine, Anesthesia and Intensive Care Clinic, Università di Udine, Udine, Italy.
  • Bignami E; Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
  • Della Corte F; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
  • Tarquini R; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
  • De Robertis E; Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy.
  • Vaschetto R; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
Respir Care ; 66(6): 983-993, 2021 Jun.
Article em En | MEDLINE | ID: mdl-33906957
BACKGROUND: The assessment of diaphragmatic kinetics through tissue Doppler imaging (dTDI) was recently proposed as a means to describe diaphragmatic activity in both healthy individuals and intubated patients undergoing weaning from mechanical ventilation. Our primary aim was to investigate whether the diaphragmatic excursion velocity measured with dTDI at the end of a spontaneous breathing trial (SBT) was different in subjects successfully extubated versus those who passed the trial but exhibited extubation failure within 48 h after extubation. METHODS: We enrolled 100 adult subjects, all of whom had successfully passed a 30-min SBT conducted in CPAP of 5 cm H2O. In cases of extubation failure within 48 h after liberation from invasive mechanical ventilation, subjects were re-intubated or supported through noninvasive ventilation. dTDI was performed at the end of the SBT to assess excursion, velocity, and acceleration. RESULTS: Extubation was successful in 79 subjects, whereas it failed in 21 subjects. The median (interquartile range [IQR]) inspiratory peak excursion velocity (3.1 [IQR 2.0-4.3] vs 1.8 [1.3-2.6] cm/s, P < .001), mean velocity (1.6 [IQR 1.2-2.4] vs 1.1 [IQR 0.8-1.4] cm/s, P < .001), and acceleration (8.8 [IQR 5.0-17.8] vs 4.2 [IQR 2.4-8.0] cm/s2, P = .002) were all significantly higher in subjects who failed extubation compared with those who were successfully extubated. Similarly, the median expiratory peak relaxation velocity (2.6 [IQR 1.9-4.5] vs 1.8 [IQR 1.2-2.5] cm/s, P < .001), mean velocity (1.1 [IQR 0.7-1.7] vs 0.9 [IQR 0.6-1.0] cm/s, P = .002), and acceleration (11.2 [IQR 9.1-19.0] vs 7.1 [IQR 4.6-12.0] cm/s2, P = .004) were also higher in the subjects who failed extubation. CONCLUSIONS: In our setting, at the end of SBT, subjects who developed extubation failure within 48 h after extubation experienced a greater diaphragmatic activation compared with subjects who were successfully extubated. (ClinicalTrials.gov registration NCT03962322.).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Desmame do Respirador / Extubação Limite: Adult / Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Desmame do Respirador / Extubação Limite: Adult / Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article