The combined use of parasternal intercostal muscle thickening fraction and P0.1 for prediction of weaning outcomes

Guojun He; Yijiao Han; Yasheng Zhan; Yake Yao; Hua Zhou; Xia Zheng

doi:10.1016/j.hrtlng.2023.07.002

The combined use of parasternal intercostal muscle thickening fraction and P0.1 for prediction of weaning outcomes

Heart Lung. 2023 Nov-Dec:62:122-128. doi: 10.1016/j.hrtlng.2023.07.002. Epub 2023 Jul 20.

Authors

Guojun He¹, Yijiao Han², Yasheng Zhan³, Yake Yao⁴, Hua Zhou⁵, Xia Zheng⁶

Affiliations

¹ Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China; Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China.
² Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China.
³ Department of Critical Care Medicine, Jinhua People's Hospital, Jinhua, Zhejiang 321000, PR China.
⁴ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China.
⁵ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China. Electronic address: zhouhua1@zju.edu.cn.
⁶ Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China; Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China. Electronic address: zxicu@zju.edu.cn.

PMID: 37480723
DOI: 10.1016/j.hrtlng.2023.07.002

Abstract

Background: A variety of parameters and diaphragmatic ultrasound in ventilator weaning has been studied extensively, and the findings yield inconsistent conclusions. The parasternal intercostal muscle holds important substantial respiratory reserve capacity when the central drive is enhanced, the predictive value of combining parasternal intercostal muscle ultrasound parameters with P0.1(airway occlusion pressure at 100 msec) in assessing ventilator weaning outcomes is still unknown.

Objectives: Our study aimed to evaluate the predictive efficacy of parasternal intercostal muscle ultrasound in conjunction with P0.1 in determining weaning failure.

Methods: We recruited patients who had been admitted to ICU and had been receiving mechanical ventilation for over two days. All patients underwent a half-hour spontaneous breathing trial (SBT) with low-level pressure support ventilation (PSV). They were positioned semi-upright for parasternal intercostal muscle ultrasound evaluations, including parasternal intercostal muscle thickness (PIMT), and parasternal intercostal muscle thickening fraction (PIMTF); P0.1 was obtained from the ventilator. Weaning failure was defined as the need for non-invasive positive pressure ventilation or re-intubation within 48 h post-weaning.

Results: Of the 56 enrolled patients with a mean age of 63.04 ± 15.80 years, 13 (23.2%) experienced weaning failure. There were differences in P0.1 (P = .001) and PIMTF (P = .017) between the two groups, but also in patients with a diaphragm thickness ≥ 2 mm. The predictive threshold values were PIMTF ≥ 13.15% and P0.1 ≥ 3.9 cmH₂O for weaning failure. The AUROC for predicting weaning failure was 0.721 for PIMTF, 0.792 for P0.1, and 0.869 for the combination of PIMTF and P0.1.

Conclusions: The parasternal intercostal muscle thickening fraction and P0.1 are independently linked to weaning failure, especially in patients with normal diaphragm thickness. The combination of parasternal intercostal muscle thickening fraction and P0.1 can serve as a valuable tool for the precise clinical prediction of weaning outcomes.

Trial registration: Chinese Clinical Trial Registry website (ChiCTR2200065422).

Keywords: Critical care; Mechanical ventilation; Parasternal intercostal muscle ultrasound, P0.1; Weaning.