Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study

Abstract Background Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction...

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Main Authors: Luigi Vetrugno, Daniele Orso, Francesco Corradi, Gianluca Zani, Savino Spadaro, Francesco Meroi, Natascia D’Andrea, Tiziana Bove, Gianmaria Cammarota, Edoardo De Robertis, Samuele Ferrari, Marcello Guarnieri, Margherita Ajuti, Maurizio Fusari, Domenico Luca Grieco, Cristian Deana, Enrico Boero, Federico Franchi, Sabino Scolletta, Salvatore Maurizio Maggiore, Francesco Forfori
Format: Article
Language:English
Published: BMC 2022-08-01
Series:Respiratory Research
Subjects:
Online Access:https://doi.org/10.1186/s12931-022-02138-y
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author Luigi Vetrugno
Daniele Orso
Francesco Corradi
Gianluca Zani
Savino Spadaro
Francesco Meroi
Natascia D’Andrea
Tiziana Bove
Gianmaria Cammarota
Edoardo De Robertis
Samuele Ferrari
Marcello Guarnieri
Margherita Ajuti
Maurizio Fusari
Domenico Luca Grieco
Cristian Deana
Enrico Boero
Federico Franchi
Sabino Scolletta
Salvatore Maurizio Maggiore
Francesco Forfori
author_facet Luigi Vetrugno
Daniele Orso
Francesco Corradi
Gianluca Zani
Savino Spadaro
Francesco Meroi
Natascia D’Andrea
Tiziana Bove
Gianmaria Cammarota
Edoardo De Robertis
Samuele Ferrari
Marcello Guarnieri
Margherita Ajuti
Maurizio Fusari
Domenico Luca Grieco
Cristian Deana
Enrico Boero
Federico Franchi
Sabino Scolletta
Salvatore Maurizio Maggiore
Francesco Forfori
author_sort Luigi Vetrugno
collection DOAJ
description Abstract Background Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation. Methods This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure. Results Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7–22). Median DTF within 24 h since the start of weaning was 28% (IQR 22–39%), RASS score (− 2 vs − 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO2/FiO2 ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 1027; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO2/FiO2 ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004). Conclusions DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further. Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).
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spelling doaj.art-0064a3327e0f44daac29ff8b55d10e1d2022-12-22T02:15:52ZengBMCRespiratory Research1465-993X2022-08-012311710.1186/s12931-022-02138-yDiaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter studyLuigi Vetrugno0Daniele Orso1Francesco Corradi2Gianluca Zani3Savino Spadaro4Francesco Meroi5Natascia D’Andrea6Tiziana Bove7Gianmaria Cammarota8Edoardo De Robertis9Samuele Ferrari10Marcello Guarnieri11Margherita Ajuti12Maurizio Fusari13Domenico Luca Grieco14Cristian Deana15Enrico Boero16Federico Franchi17Sabino Scolletta18Salvatore Maurizio Maggiore19Francesco Forfori20Department of Medical, Oral and Biotechnological Sciences, University of Chieti-PescaraDepartment of Medicine (DAME), University of UdineDepartment of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of PisaDepartment of Anesthesia and Intensive CareDepartment of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, University of Ferrara, Sant’Anna HospitalDepartment of Medicine (DAME), University of UdineDepartment of Medicine (DAME), University of UdineDepartment of Medicine (DAME), University of UdineDepartment of Medicine and Surgery, Università degli Studi di PerugiaDepartment of Medicine and Surgery, Università degli Studi di PerugiaDepartment of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of PisaDepartment of Anesthesia and Intensive Care, Niguarda HospitalDepartment of Anesthesia and Intensive Care, Niguarda HospitalDepartment of Anesthesia and Intensive CareIntensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSDepartment of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of UdineDipartimento di Scienze Chirurgiche, Università degli Studi di TorinoDepartment of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of SienaDepartment of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of SienaDepartment of Medical, Oral and Biotechnological Sciences, University of Chieti-PescaraDepartment of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of PisaAbstract Background Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation. Methods This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure. Results Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7–22). Median DTF within 24 h since the start of weaning was 28% (IQR 22–39%), RASS score (− 2 vs − 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO2/FiO2 ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 1027; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO2/FiO2 ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004). Conclusions DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further. Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).https://doi.org/10.1186/s12931-022-02138-yDiaphragmCOVID-19Mechanical ventilationUltrasoundWeaning failure
spellingShingle Luigi Vetrugno
Daniele Orso
Francesco Corradi
Gianluca Zani
Savino Spadaro
Francesco Meroi
Natascia D’Andrea
Tiziana Bove
Gianmaria Cammarota
Edoardo De Robertis
Samuele Ferrari
Marcello Guarnieri
Margherita Ajuti
Maurizio Fusari
Domenico Luca Grieco
Cristian Deana
Enrico Boero
Federico Franchi
Sabino Scolletta
Salvatore Maurizio Maggiore
Francesco Forfori
Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study
Respiratory Research
Diaphragm
COVID-19
Mechanical ventilation
Ultrasound
Weaning failure
title Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study
title_full Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study
title_fullStr Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study
title_full_unstemmed Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study
title_short Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study
title_sort diaphragm ultrasound evaluation during weaning from mechanical ventilation in covid 19 patients a pragmatic cross section multicenter study
topic Diaphragm
COVID-19
Mechanical ventilation
Ultrasound
Weaning failure
url https://doi.org/10.1186/s12931-022-02138-y
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