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Master Thesis

Mesure échographique de l’excursion diaphragmatique : nouveau critère prédictif d’échec de sevrage en réanimation ?

Abstract : Purpose. To assess the ability of diaphragmatic ultrasound (US) to predict weaning failure in mechanically ventilated ICU patients undergoing a first spontaneous breathing trial (SBT). Methods. All patients eligible for a first SBT underwent US measurements of maximal end-expiratory diaphragmatic excursion (EDEmax) by a right anterior subcostal approach. Primary weaning failure was defined as either the failure of SBT or the need for resumption of ventilatory support for acute respiratory failure or death within 48 h following successful extubation. Diaphragmatic US was compared with maximal inspiratory pressure (MIP), forced vital capacity (FVC) and MRC score measured whenever possible before the first SBT. Results. During a 6-month period, 67 patients were included and 22 (33%) presented a weaning failure after a first SBT. Using a threshold of EDEmax ≤ 2.7 cm, the sensitivity and specificity of diaphragmatic ultrasound in predicting non-cardiogenic weaning failure were 71% [47 – 87%] and 71% [57 – 82%]. There was no significant difference between the receiver operator characteristic curves of diaphragmatic excursion, functional respiratory parameters and Medical Research Council (MRC) score. In univariate analysis, EDEmax ≤ 2.7 cm was significantly associated with weaning failure with odds ratios of 3.56 (95% CI: 1.25 – 10.1; p = 0.02). However, a MRC score ≤ 48 was not statistically associated with weaning failure (OR = 2 [0.72 – 5.6]; p = 0.2). Conclusion. A decrease in maximal diaphragmatic excursion may be associated with an unfavorable weaning outcome regardless of a peripheral neuromuscular involvement assessed by the MRC score.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01246627
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Submitted on : Friday, December 18, 2015 - 6:34:39 PM
Last modification on : Wednesday, August 23, 2017 - 4:32:43 PM
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Éline Bonnardel. Mesure échographique de l’excursion diaphragmatique : nouveau critère prédictif d’échec de sevrage en réanimation ?. Médecine humaine et pathologie. 2015. ⟨dumas-01246627⟩

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