Ultrassonografia diafragmática como preditora de desmame ventilatório: uma revisão sistemática

Autores

DOI:

https://doi.org/10.33233/rbfex.v21i3.5282

Palavras-chave:

ultrassom diafragmático, ventilação mecânica, desmame, extubação

Resumo

Objetivo: Revisar as evidências sobre a ultrassonografia diafragmática como preditor de sucesso no desmame ventilatório, usando a metodologia PICO e palavras-chave: Ultrassom, Diagnóstico por imagem, Diafragma, Desmame, Unidade de Terapia Intensiva, Respiração Artificial, Ventilação Mecânica, Desmame do Ventilador. Métodos: Estudos de coorte publicados foram usados ​​sem restrições de idioma e ano que abordaram o uso de ultrassom para prever o sucesso no desmame e extubação ventilatória. Foram excluídos estudos com pacientes menores de 18 anos, relatos de casos, revisões de literatura, resultados que não trouxessem valor de corte para espessura e excursão diafragmática e definição de falha no processo de desmame e extubação. Resultados: Foram encontrados 459 estudos; após exclusão por duplicação e leitura de títulos e resumo, apenas 11 foram selecionados pelos critérios de inclusão. As amostras variaram de 34 a 193 indivíduos. Conclusão: Podemos evidenciar que o uso da USG para avaliar a espessura e excursão do diafragma em pacientes submetidos a suporte ventilatório invasivo é eficaz em predizer o sucesso no processo de desmame e extubação. A ultrassonografia diafragmática tem grande aplicabilidade para avaliar a capacidade de predizer sucesso ou falha na remoção do suporte ventilatório invasivo.

Biografia do Autor

André Luiz Lisboa Cordeiro, UFBA

Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Centro Universitário Nobre, Feira de Santana, BA, Brasil

Lucas Oliveira Soares, UNIFAN

Centro Universitário Nobre, Feira de Santana, BA, Brasil

Késsia Morgana Vital Oliveira, UNIFAN

Centro Universitário Nobre, Feira de Santana, BA, Brasil

Amanda Maria Garcez de Oliveira de Jesus, UNIFAN

Centro Universitário Nobre, Feira de Santana, BA, Brasil

Referências

Varón-Vega F, Hernández A, López M, Cáceres E, Giraldo-Cadavid LF, Uribe-Hernandez AM, Crevoisier S. Usefulness of diaphragmatic ultrasound in predicting extubation success. Med Intensiva (Engl Ed) 2021;45(4):226-33. doi: 10.1016/j.medin.2019.10.007

Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from mechanical ventilation in critically ill adult rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. Am J Respir Crit Care Med 2017;195:120-33. doi: 10.1164/rccm.201610-2075ST

Grasse A, Ferlicca D, Lupieri E, Calcinati S, Francesconi S, Sala V, et al. Assisted mechanical ventilation promotes recovery of diaphragmatic thickness in critically ill patients: a prospective observational study. Critical Care 2020;24:85. doi: 10.1186/s13054-020-2761-6

Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med 2018;197(2):204-13. doi: 10.1164/rccm.201703-0536OC

Sklar MC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Association of low baseline diaphragm muscle mass with prolonged mechanical ventilation and mortality among critically ill adults. JAMA Network Open 2020;3(2):e1921520. doi: 10.1001/jamanetworkopen.2019.21520

Dres M, Dubé B-P, Mayaux J, Delemazure J, Reuter D, Brochard L, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med 2017;195(1):57-66. doi: 10.1164/rccm.201602-0367OC

Medrinal C, Prieur G, Frenoy E, Quesada AR, Poncet A, Bonnevie T, et al. Respiratory weakness after mechanical ventilation is associated with one-year mortality - a prospective study. Crit Care 2016;20(1):231. doi: 10.1186/s13054-016-1418-y

Geiseler J, Kelbe C. Weaning from mechanical ventilation. Weaning categories and weaning concepts. Med Klin Intensivmed Notfmed 2016;111:208-14. doi: 10.1007/s00063-016-0147-y

Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, et al. Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort. Am J Respir Crit Care Med 2015;192(9):1080. doi: 10.1164/rccm.201503-0620OC

Palkar A, Mayo P, Singh K, Koenig S, Narasimhan M, Singh A, et al. Serial diaphragm ultrasonography to predict successful discontinuation of mechanical ventilation. Lung 2018;196:363-8. doi: 10.1007/s00408-018-0106-x

Öztürk E, Tanıdır İC, Yıldız O, Yükçü B, Ergün S, Haydın S, et al. Ultrasonographic postoperative evaluation of diaphragm function of patients with congenital heart defects. Turk Gogus Kalp Dama 2020;28(1):70-5. doi: 10.5606/tgkdc.dergisi.2020.18458

Abbas A, Embarak S, Walaa M, Lutfy SM. Role of diaphragmatic rapid shallow breathing index in predicting weaning outcome in patients with acute exacerbation of COPD. Int J COPD 2018;13:1655-61. doi: 10.2147/COPD.S161691

Carrie C, Gisbert-Morae C, Bonnardel E, Gauche B, Matthieu B, Vargas F, et al. Ultrasonographic diaphragmatic excursion is inaccurate and not better than the MRC score for predicting weaning-failure in mechanically ventilated patients. Anaesth Crit Care Pain Med 2016:1-27. doi: 10.1016/j.accpm.2016.05.009

Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest 2017;1 52 (6):1140-50. doi.org/10.1016/j.chest.2017.08.028

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med.2009;6(7):e1000097

Sklar MC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Association of low baseline diaphragm muscle mass with prolonged mechanical ventilation and mortality among critically Ill Adults. JAMA Network Open. 2020;3(2):e1921520. doi: 10.1001/jamanetworkopen.2019.21520

Viver E, Muller M, Putegnat Jean-Baptiste, Steyer J, Barrau S, Boissier F, et al. Inability of diaphragm ultrasound to predict extubation failure a multicenter study. Chest 2019;155(6):1131-9. doi: 10.1016/j.chest.2019.03.004

Eltrabili HH, Hasanin AM, Soliman MS, Lofty AM, Hamimy WI, Mukhtar AM. Evaluation of diaphragmatic ultrasound indices as predictors of successful liberation from mechanical ventilation in subjects with abdominal sepsis. Respir Care 2019;64(5):564-9. doi: 10.4187/respcare.06391

Zhang X, Yuan J, Zhan Y, Wu J, Liu B, Zhand P, Yu T, et al. Evaluation of diaphragm ultrasound in predicting extubation outcome in mechanically ventilated patients with COPD. Ir J Med Sci 2020;189(2):661-8. doi: 10.1007/s11845-019-02117-1

Palkar A, Mayo P, Singh K, Koenig S, Narasimhan, Singh A, et al. Serial diaphragm ultrasonography to predict successful discontinuation of mechanical ventilation. Lung 2018;196(3):363-8. doi: 10.1007/s00408-018-0106-x

Dres M, Dube Bruno-Pierre, Mayaux J, Delemazure J, Reuter D, Brochard L, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med 2017;195(1):57-66. doi: 10.1164/rccm.201602-0367OC

Khan M, Munawar K, Hussain S, Qadeer A, Saeed ML, Shad ZS, et al. Comparing ultrasound-based diaphragmatic excursion with rapid shallow breathing index as a weaning predictor. Cureus 2018;10(12):3710. doi: 10.7759/cureus.3710

Soliman SB, Ragab F, Soliman RA, Gaber A, Kamal A. Chest Ultrasound in predication of weaning failure. Open Access Maced J Med Sci 2019;7(7):1143-47. doi: 10.3889/oamjms.2019.277

Huang D, Ma H, Zhong W, Wang X, Wu Y, Qin T, et al. Using M-mode ultrasonography to assess diaphragm dysfunction and predict the success of mechanical ventilation weaning in elderly patients. J Thorac Dis 2017;9(9):3177-86. doi: 10.21037/jtd.2017.08.16

Pirompanich P, Romsaiyut S. Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients. J Intensive Care 2018;6:6. https://10.1186/s40560-018-0277-9

Yoo Jung-Wan, Lee SJ, Lee JD, Kim HC. Comparison of clinical utility between diaphragm excursion and thickening change using ultrasonography to predict extubation success. Korean J Intern Med 2018;33:331-9. doi: 10.3904/kjim.2016.152.e1

Publicado

2022-11-24