PDF(Pubmed)
Abstract：
BACKGROUND: The ratio (E/Ea) of mitral Doppler inflow velocity to annular tissue Doppler wave velocity by transthoracic echocardiography and diaphragmatic excursion (DE) by diaphragm ultrasound have been confirmed to predict extubation outcomes. However, few studies focused on the predicting value of E/Ea and DE at different positions during a spontaneous breathing trial (SBT), as well as the effects of △E/Ea and △DE (changes in E/Ea and DE during a SBT).
METHODS: This study was a reanalysis of the data of 60 difficult-to-wean patients in a previous study published in 2017. All eligible participants were organized into respiratory failure (RF) group and extubation success (ES) group within 48 h after extubation, or re-intubation (RI) group and non-intubation (NI) group within 1 week after extubation. The risk factors for respiratory failure and re-intubation including E/Ea and △E/Ea, DE and △DE at different positions were analyzed by multivariate logistic regression, respectively. The receiver operating characteristic (ROC) curves of E/Ea (septal, lateral, average) and DE (right, left, average) were compared with each other, respectively.
RESULTS: Of the 60 patients, 29 cases developed respiratory failure within 48 h, and 14 of those cases required re-intubation within 1 week. Multivariate logistic regression showed that E/Ea were all associated with respiratory failure, while only DE (right) and DE (average) after SBT were related to re-intubation. There were no statistic differences among the ROC curves of E/Ea at different positions, nor between the ROC curves of DE. No statistical differences were shown in △E/Ea between RF and ES groups, while △DE (average) was remarkably higher in NI group than that in RI group. However, multivariate logistic regression analysis showed that △DE (average) was not associated with re-intubation.
CONCLUSIONS: E/Ea at different positions during a SBT could predict postextubation respiratory failure with no statistical differences among them. Likewise, only DE (right) and DE (average) after SBT might predict re-intubation with no statistical differences between each other.
METHODS: This study was a reanalysis of the data of 60 difficult-to-wean patients in a previous study published in 2017. All eligible participants were organized into respiratory failure (RF) group and extubation success (ES) group within 48 h after extubation, or re-intubation (RI) group and non-intubation (NI) group within 1 week after extubation. The risk factors for respiratory failure and re-intubation including E/Ea and △E/Ea, DE and △DE at different positions were analyzed by multivariate logistic regression, respectively. The receiver operating characteristic (ROC) curves of E/Ea (septal, lateral, average) and DE (right, left, average) were compared with each other, respectively.
RESULTS: Of the 60 patients, 29 cases developed respiratory failure within 48 h, and 14 of those cases required re-intubation within 1 week. Multivariate logistic regression showed that E/Ea were all associated with respiratory failure, while only DE (right) and DE (average) after SBT were related to re-intubation. There were no statistic differences among the ROC curves of E/Ea at different positions, nor between the ROC curves of DE. No statistical differences were shown in △E/Ea between RF and ES groups, while △DE (average) was remarkably higher in NI group than that in RI group. However, multivariate logistic regression analysis showed that △DE (average) was not associated with re-intubation.
CONCLUSIONS: E/Ea at different positions during a SBT could predict postextubation respiratory failure with no statistical differences among them. Likewise, only DE (right) and DE (average) after SBT might predict re-intubation with no statistical differences between each other.
摘要：
背景：经胸超声心动图显示的二尖瓣多普勒流入速度与环形组织多普勒波速度的比值（E/Ea）和膈肌超声显示的膈肌偏移（DE）已被证实可以预测拔管结果。然而,很少有研究集中在自主呼吸试验（SBT）过程中不同位置的E/Ea和DE的预测值，以及△E/Ea和△DE的影响（SBT期间E/Ea和DE的变化）。
方法：这项研究是对2017年发表的先前研究中60名难以断奶的患者的数据进行的重新分析。所有符合条件的参与者在拔管后48h内分为呼吸衰竭(RF)组和拔管成功(ES)组。拔管后1周内或再插管（RI）组和非插管（NI）组。呼吸衰竭和再插管的危险因素包括E/Ea和△E/Ea。采用多元逻辑回归分析不同位置的DE和△DE，分别。E/Ea(间隔，横向,平均值)和DE(右，左,平均值)相互比较，分别。
结果：在60名患者中，29例48h内出现呼吸衰竭,其中14例需要在1周内重新插管。多因素logistic回归分析显示E/Ea均与呼吸衰竭相关,而SBT后只有DE（右）和DE（平均）与再插管有关。E/Ea在不同位置的ROC曲线之间没有统计学差异。在DE的ROC曲线之间也是如此。RF组和ES组△E/Ea差异无统计学意义。NI组的△DE（平均值）明显高于RI组。然而,多因素logistic回归分析显示△DE(平均值)与再次插管无关。
结论：在SBT期间不同位置的E/Ea可以预测拔管后呼吸衰竭，但它们之间没有统计学差异。同样，SBT后只有DE(右)和DE(平均)可以预测再次插管,彼此之间没有统计学差异.
方法：这项研究是对2017年发表的先前研究中60名难以断奶的患者的数据进行的重新分析。所有符合条件的参与者在拔管后48h内分为呼吸衰竭(RF)组和拔管成功(ES)组。拔管后1周内或再插管（RI）组和非插管（NI）组。呼吸衰竭和再插管的危险因素包括E/Ea和△E/Ea。采用多元逻辑回归分析不同位置的DE和△DE，分别。E/Ea(间隔，横向,平均值)和DE(右，左,平均值)相互比较，分别。
结果：在60名患者中，29例48h内出现呼吸衰竭,其中14例需要在1周内重新插管。多因素logistic回归分析显示E/Ea均与呼吸衰竭相关,而SBT后只有DE（右）和DE（平均）与再插管有关。E/Ea在不同位置的ROC曲线之间没有统计学差异。在DE的ROC曲线之间也是如此。RF组和ES组△E/Ea差异无统计学意义。NI组的△DE（平均值）明显高于RI组。然而,多因素logistic回归分析显示△DE(平均值)与再次插管无关。
结论：在SBT期间不同位置的E/Ea可以预测拔管后呼吸衰竭，但它们之间没有统计学差异。同样，SBT后只有DE(右)和DE(平均)可以预测再次插管,彼此之间没有统计学差异.
