Integration of Diaphragmatic Ultrasonography and Intra-Abdominal Pressure Measurement for Optimizing Weaning from Mechanical Ventilation

Dan Su,1,* Ruixin Li,1,* Zhi Chen,2 Na Cui,1 Zhanbiao Yu,1 Xiaoxu Ding,1 Jiaqian Wu1 1Intensive Care Unit, The Affiliated Hospital of Hebei University, Baoding, Hebei Province, 071000, People’s Republic of China; 2Department of Hepatobiliary Surgery, The Affiliated Hospital of Hebei University, Baoding, Hebei Province, 071000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhi Chen, Department Hepatobiliary Surgery, The Affiliated Hospital of Hebei University, No. 212 of Yuhua Road, Lianchi District, Baoding, Hebei Province, 071000, People’s Republic of China, Tel +86 13832296881, Fax +86 0312-5983782, Email [email protected] Na Cui, Intensive Care Unit, The Affiliated Hospital of Hebei University, No. 212 of Yuhua Road, Lianchi District, Baoding, Hebei Province, 071000, People’s Republic of China, Tel +86 13503382865, Fax +86 0312 5983752, Email [email protected]: The objective of this study was to evaluate the effectiveness of diaphragmatic ultrasonography in conjunction with intra-abdominal pressure (IAP) measurement for assessing diaphragm function and determining the optimal timing for weaning from mechanical ventilation (MV).Methods: A cohort of 100 patients undergoing MV at the intensive care department of the Affiliated Hospital of Hebei University between January 2023 and July 2023 was enrolled. Spontaneous breathing trials (SBTs) were performed once patients met the weaning criteria. At the 30-minute mark of the SBT, diaphragmatic ultrasonography and IAP measurements were conducted. Based on weaning outcomes, patients were categorized into successful and failed weaning groups. Diaphragmatic excursion (DE), diaphragm thickening fraction (TFdi), diaphragmatic rapid shallow breathing index (D-RSBI), and IAP were compared between groups. The predictive value of these parameters in determining optimal weaning timing was analyzed using receiver operator characteristic (ROC) curves.Results: Compared to the failed weaning group, the successful weaning group exhibited significantly lower values of D-RSBI and IAP values along with higher values of DE, TFdi, diaphragm thickness at end-inhalation (DTei), and diaphragm thickness at end-exhalation (DTee) (p < 0.05). In the single-parameter analysis, the area under the curve (AUC) values for D-RSBI, DE, TFdi, and IAP were 0.880 (95% CI: 0.811– 0.948), 0.981 (95% CI: 0.960– 1.000), 0.907 (95% CI: 0.872– 0.972), and 0.838 (95% CI: 0.748– 0.929), respectively. The optimal cut-off values were 13.5 breaths /(min*cm), 1.2 cm, 29.3%, and 5.6 mmHg, respectively. In combined parameter analysis, the combination of IAP and DE demonstrated the highest predictive accuracy.Conclusion: The integration of diaphragmatic ultrasonography with IAP measurement is an effective approach for predicting weaning outcomes in patients undergoing MV. This combined assessment may assist clinicians in optimizing weaning strategies and improving patient outcomes.Keywords: diaphragmatic ultrasonography, IAP, intra-abdominal pressure, MV, mechanical ventilation