RESEARCH ARTICLE


Sonographically Measured Improvement in Diaphragmatic Mobility and Outcomes Among Patients Requiring Prolonged Weaning from the Ventilator



N Gibis1, A Schulz1, S Vonderbank1, M Boyko1, H Gürleyen1, X Schulz2, A Bastian1, *
1 Marienkrankenhaus Kassel, Marburger Str. 85, 34127 Kassel, Germany
2 Department of Medical Statistics, University Medical Center Göttingen, Georg-August-Universität, Humboldtallee 32, 37073 Göttingen, Germany

Article Information


Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 38
Last Page: 44
Publisher ID: TORMJ-13-38
DOI: 10.2174/1874306401913010038

Article History:

Received Date: 29/03/2019
Revision Received Date: 18/06/2019
Acceptance Date: 20/06/2019
Electronic publication date: 25/06/2019
Collection year: 2019

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Creative Commons License
© 2019 Gibis et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Marienkrankenhaus Kassel, Marburger Str. 85, 34127 Kassel, Germany; Tel: 004956180731212;
Fax: 004956180734200; E-mails: a.bastian@marienkrankenhaus-kassel.de


Abstract

Background:

The need of prolonged weaning from the ventilator is a well-known predictor of an unfavorable patients` outcome. Diaphragmatic dysfunction is a serious problem for these patients. We wanted to determine the survival in patients who were already intubated for more than 4 weeks before they were admitted to our weaning unit. In this prospective study, we wanted to investigate if the diaphragmatic function could improve or was related to survival over an 18 months follow up period.

Methods:

84 patients were included when they were able to breathe at least 10 minutes over a t-piece and sit upright for at least 5 minutes. The diaphragmatic function was estimated sonographically using the up and downward movement of the lung silhouette. Sonographic follow-ups were performed for over 18 months. The survival rate, outcome and changes in diaphragm mobility were investigated.

Results:

a) Survival: 49 patients (58%) survived the 18 months follow up period - 30 had a good outcome; 19 needed assistance. b) Survival in relation to diaphragm mobility: If diaphragmatic mobility improved ≥ 15.5 mm on the left side, the probability of survival was 94% with a probability of 76% to have a satisfying outcome.

Conclusion:

Survival and outcome of prolonged weaning were significantly better when sonographically measured the mobility of left hemidiaphragm improved.

Keywords: Diaphragm, Weaning, Ultrasound, Outcome, Ventilator, VIDD, COPD.