Journal of Shanghai Jiao Tong University (Medical Science) >

2025 , Vol. 45 >Issue 2: 186 - 193

DOI: https://doi.org/10.3969/j.issn.1674-8115.2025.02.007

Clinical research

Value of combined diaphragm and intercostal muscle ultrasonography in guiding weaning assessment in mechanically ventilated patients with sepsis

  • SHEN Haoliang ,
  • YUAN Kaihao ,
  • YU Lei ,
  • YANG Nana ,
  • WANG Yiping ,
  • ZHAO Hongsheng ,
  • GUO Fengmei ,
  • SUN Chenliang
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  • 1.Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China
    2.Department of Critical Care Medicine, Chengdu Fifth People's Hospital, Sichuan Province, Chengdu 611130, China
    3.Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing 210009, China
SUN Chenliang, E-mail: scl8210@163.com.

Received date: 2024-10-21

  Accepted date: 2025-01-06

  Online published: 2025-02-24

Supported by

Scientific Research Foundation of Nantong Municipal Health Commission(MS2024015)

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Abstract

Objective ·To explore the value of combined diaphragm and intercostal muscle ultrasound assessment compared with conventional diaphragm ultrasound in predicting the weaning outcome in mechanically ventilated patients with sepsis. Methods ·Mechanically ventilated patients with sepsis, consecutively admitted to the Department of Critical Care Medicine of Affiliated Hospital of Nantong University from October 2022 to December 2023, were selected. During the peri-weaning period, after the patient's sepsis condition improved and the patient passed the spontaneous breathing trial (SBT), ultrasound evaluation of respiratory muscles was performed by ultrasound qualified personnel with ultrasound qualification and experience in bedside ultrasound examination. Diaphragm excursion (DE), thickening fraction of diaphragm (TFD), and thickening fraction of intercostal muscle (TFic) were measured, respectively. The patients were divided into a successful weaning group (n=114) and a failed weaning group (n=24) according to the weaning results. Receiver operating characteristic (ROC) curves were used to analyze the value of diaphragm ultrasound and intercostal muscle ultrasound, alone and in combination, in predicting ventilator weaning outcome. Results ·TFic and TFic/TFD were significantly higher in the failed weaning group during SBT than in the successful weaning group (all P<0.05). The areas under the ROC curve (AUROC) of DE, TFD, and TFic to predict weaning failure in mechanically ventilated patients with sepsis during the period of SBT were 0.689 (0.591‒0.776), 0.657 (0.557‒0.747), and 0.769 (0.676‒0.846), respectively, whereas the combined indexes TFic/TFD and TFic&TFD_mix had AUROCs of 0.867 (0.786‒0.925) and 0.860 (0.778‒0.920), respectively. TFic/TFD with a cutoff value of >0.95 had a sensitivity of 86.7% and a specificity of 75.3% in predicting weaning failure, and TFic&TFD_mix with a cutoff value of >0.13 had a sensitivity of 86.6% and a specificity of 80.9% in predicting weaning failure. Moreover, the intercostal muscle ultrasonography method had an intra-observer intraclass correlation coefficient (ICC) of 0.890 and an extra-observer ICC of 0.876 for measurement reliability, which were both rated as good (P<0.001). Conclusion ·Combined diaphragm and intercostal muscle ultrasonography provides a more comprehensive picture of the patient's overall respiratory muscles, and has a higher guiding value in predicting the weaning outcomes in mechanically ventilated patients with sepsis than diaphragm ultrasound alone.

Key words： diaphragm ultrasound; intercostal muscle ultrasound; sepsis; mechanical ventilation; weaning assessment

Cite this article

SHEN Haoliang , YUAN Kaihao , YU Lei , YANG Nana , WANG Yiping , ZHAO Hongsheng , GUO Fengmei , SUN Chenliang . Value of combined diaphragm and intercostal muscle ultrasonography in guiding weaning assessment in mechanically ventilated patients with sepsis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025 , 45(2) : 186 -193 . DOI: 10.3969/j.issn.1674-8115.2025.02.007

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