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Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress
Critical Care Medicine, 06/22/2012
Soummer A et al. – Lung ultrasound determination of aeration changes during a successful spontaneous breathing trial may accurately predict postextubation distress.
Methods- One hundred patients were included in the study.
- Lung ultrasound, echocardiography, and plasma B–type natriuretic peptide levels were determined before and at the end of a 60–min spontaneous breathing trial and 4 hrs after extubation.
- To quantify lung aeration, a lung ultrasound score was calculated.
- Patients were followed up to hospital discharge.
- Fourteen patients failed the spontaneous breathing trial, 86 were extubated, 57 were definitively weaned (group 1), and 29 suffered from postextubation distress (group 2).
- Loss of lung aeration during the successful spontaneous breathing trial was observed only in group 2 patients: lung ultrasound scores increased from 15 [13;17] to 19 [16; 21] (p<.01).
- End–spontaneous breathing trial lung ultrasound scores were significantly higher in group 2 than in group 1 patients: 19 [16;21] vs. 10 [7;13], respectively (p<.001) and predicted postextubation distress with an area under the receiver operating characteristic curve of 0.86.
- Although significantly higher in group 2, B–type natriuretic peptide and echocardiography cardiac filling pressures were not clinically helpful in predicting postextubation distress.
