Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation: a systematic review and meta-analysis

• Published in: BMJ open Vol. 8; no. 9; p. e021189
• Main Authors: Qian, Zhicheng, Yang, Ming, Li, Lin, Chen, Yaolong
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2018; BMJ Publishing Group
• Subjects: Accuracy; Bias; Critical care; Extubation; Intensive Care; Meta-analysis; Ostomy; Patients; Plot (Narrative); Software; Statistical analysis; Systematic review; Ultrasonic imaging; Ventilators; Weaning; diaphragmatic excursion; diaphragmatic thickness fraction; diaphragmatic dysfunction; weaning mechanical ventilation
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-021189

ObjectiveThe aim of this systematic review was to assess the diaphragmatic dysfunction (DD) as a predictor of weaning outcome.BackgroundSuccessful weaning depends on several factors: muscle strength, cardiac, respiratory and metabolic. Acquired weakness in mechanical ventilation is a growing important cause of weaning failure. With the development of ultrasonography, DD can be evaluated with ultrasound in weakness patients to predict weaning outcomes.MethodsThe Cochrane Library, PubMed, Embase, Ovid Medline, WanFang Data and CNKI were systematically searched from the inception to September 2017. Ultrasound assessment of DD in adult mechanical ventilation patients was included. Two independent investigators assessed study quality in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The primary outcome was diaphragmatic thickness and excursion in the weaning success and failure group. The secondary outcome was the influence of DD on weaning outcome.ResultsEleven studies involving a total of 436 patients were included. There were eight studies comparing diaphragmatic excursion (DE), five comparing the diaphragmatic thickening fraction (DTF) and two comparing DD between groups with and without successful weaning. Overall, the DE or DTF had a pooled sensitivity of 0.85 (95% CI 0.77 to 0.91) and a pooled specificity of 0.74 (95% CI 0.66 to 0.80) for predicting weaning success. There was high heterogeneity among the included studies (I2=80%; p=0.0006). The rate of weaning failure was significantly increased in patients with DD (OR 8.82; 95% CI 3.51 to 22.13; p<0.00001).ConclusionsBoth DE and DTF showed good diagnostic performance to predict weaning outcomes in spite of limitations included high heterogeneity among the studies. DD was found to be a predictor of weaning failure in critically ill patients.