Abstract

The Role of Diaphragmatic Shallow Breathing Index in Assessment of Diaphragmatic Dysfunction and Weaning from Mechanical Ventilation

Mechanical ventilation is one of the most common interventions in critical care. Weaning patients from mechanical ventilation is a cornerstone in the management of critically ill patients as unnecessary delay can lead to further complications 20% of the intubated patients show difficulty in extubation and weaning, despite established weaning criteria. The diaphragm is the principal respiratory muscle in humans, diaphragmatic ultrasound is a simple method useful to evaluate their thickness. This technique is highly feasible, simple, and non-invasive that can be used for the evaluation of diaphragmatic functions. This study aimed to compare the ability of the traditional RSBI and D-RSBI to predict successful weaning in ready-to-wean patients. A prospective observational study was conducted on 40 mechanically ventilated patients. In our study, DTF, DE, Rapid Shallow Breathing Index (RSBI), and Diaphragmatic Rapid Shallow Breathing Index (D-RSBI) were calculated for all those patients and correlated with the possibility of weaning. Weaned patients from mechanical ventilation were also followed up within the upcoming 48 hours for the risk of reintubation. The study population was subdivided into two groups; successful and failed weaning groups where 26 patients (65%) were weaned successfully from mechanical ventilation while 14 patients (35%) had failed the weaning trial. A statistically significant difference was found between each of DTF, Excursion, RBSI, and D-RBSI and weaning outcome (p=0.001, <0.001, 0.008, and <0.001) respectively in the study groups. DTF and Excursion were found higher in the successful weaning groups while RBSI and D-RBSI were found lower in the successful weaning groups. A Receiver Operating Characteristic (ROC) curve was calculated for DTF, DE, RSBI, and D-RSBI as indexes for successful weaning, and the cut-off point was ≥ 0.30, ≥ 19mm, ≤ 61 breaths/min/L, and ≤ 1.8 breaths/min/mm respectively. The D-RBSI was found as the most independent predictor of successful weaning by multivariate logistic regression with p-value=0.005.

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