Author:
Zhang Rui,Xu Xiaoting,Chen Hui,Beck Jennifer,Sinderby Christer,Qiu Haibo,Yang Yi,Liu Ling
Abstract
Abstract
Background
The unsuccessful extubation in patients with traumatic cervical spinal cord injuries (CSCI) may result from impairment diaphragm function and monitoring of diaphragm electrical activity (EAdi) can be informative in guiding extubation. We aimed to evaluate whether the change of EAdi during a single maximal maneuver can predict extubation outcomes in CSCI patients.
Methods
This is a retrospective study of CSCI patients requiring mechanical ventilation in the ICU of a tertiary hospital. A single maximal maneuver was performed by asking each patient to inhale with maximum strength during the first spontaneous breathing trial (SBT). The baseline (during SBT before maximal maneuver), maximum (during the single maximal maneuver), and the increase of EAdi (ΔEAdi, equal to the difference between baseline and maximal) were measured. The primary outcome was extubation success, defined as no reintubation after the first extubation and no tracheostomy before any extubation during the ICU stay.
Results
Among 107 patients enrolled, 50 (46.7%) were extubated successfully at the first SBT. Baseline EAdi, maximum EAdi, and ΔEAdi were significantly higher, and the rapid shallow breathing index was lower in patients who were extubated successfully than in those who failed. By multivariable logistic analysis, ΔEAdi was independently associated with successful extubation (OR 2.03, 95% CI 1.52–3.17). ΔEAdi demonstrated high diagnostic accuracy in predicting extubation success with an AUROC 0.978 (95% CI 0.941–0.995), and the cut-off value was 7.0 μV.
Conclusions
The increase of EAdi from baseline SBT during a single maximal maneuver is associated with successful extubation and can help guide extubation in CSCI patients.
Funder
National Key R&D Program of China
Clinical Science and Technology Specific Projects of Jiangsu Province
National Natural Science Foundation of China
Second Level Talents of the “333 High Level Talents Training Project” in the sixth phase in Jiangsu
Jiangsu Provincial Medical Key Laboratory
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Cited by
1 articles.
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