Diaphragm Thickening Fraction for Predicting Esophageal Pressure and Ventilator Weaning in Children.

research_question

How well does DTF correlate with ΔPes and predict weaning and extubation outcomes?

DTF与ΔPes的相关性如何，以及它如何预测撤机和拔管的结果？

study_design_and_methods

In this secondary analysis of children with ARDS from a single-center randomized control trial, DTF and ΔPes were measured daily during mechanical ventilation and during spontaneous breathing trials (SBTs; CPAP, 5 cm H2O).

在这项针对单中心随机对照试验中患有急性呼吸窘迫综合征（ARDS）的儿童的二次分析中，动态顺应性（DTF）和食管压力变化（ΔPes）在机械通气期间以及在自发性呼吸试验（SBTs；持续气道正压通气，5 cm H2O）期间每天进行测量。

SBT outcomes were classified as early failure (SBT failure within 30 minutes), late failure (SBT failure between 30 and 120 minutes), and SBT success.

自发性呼吸试验（SBT）的结果被分类为早期失败（SBT在30分钟内失败）、晚期失败（SBT在30至120分钟之间失败）和SBT成功。

Extubation outcomes were classified as prolonged noninvasive ventilation (NIV; > 72 hours), reintubation within 48 hours, and successful extubation.

拔管结果被分类为长期无创通气（NIV；> 72小时）、48小时内重新插管和成功拔管。

Results

The study included 194 patients with 704 daily measurements.

该研究包括194名患者，共进行了704次每日测量。

The correlation between the daily DTF and ΔPes was r = 0.10 (95% CI, 0.01-0.19).

每日DTF与ΔPes之间的相关系数为r = 0.10（95%置信区间，0.01-0.19）。

One hundred seventy-one SBTs showed successful results, 60 SBTs showed early failures, and 88 SBTs showed late failures, with no difference in the median SBT DTF among groups (early failure, 20% [95% CI, 10%-32%]; late failure, 18% [95% CI, 12%-26%]; and success, 19% [95% CI, 11%-28%]; P = .69).

171次SBT显示出成功的结果，60次SBT显示出早期失败，88次SBT显示出晚期失败，各组之间的SBT DTF中位数没有差异（早期失败，20% [95%置信区间，10%-32%]；晚期失败，18% [95%置信区间，12%-26%]；成功，19% [95%置信区间，11%-28%]；P = .69）。

The SBT DTF was not predictive of extubation success or failure (reintubation or prolonged NIV; area under the receiver operating characteristic curve, 0.54 [95% CI, 0.44-0.64]), with the median SBT DTF of 19% (interquartile range [IQR], 11%-31%; n = 124) for those successfully extubated; 23% (IQR, 16%-30%; n = 12) for those reintubated; and 17% (IQR, 10%-23%; n = 30) for those who received prolonged NIV (P = .3).

SBT DTF无法预测拔管成功或失败（重新插管或长期NIV；受试者工作特征曲线下面积，0.54 [95% 置信区间, 0.44-0.64]），成功拔管者的中位数SBT DTF为19%（四分位数间距[IQR]，11%-31%；n = 124）；重新插管者的为23%（IQR，16%-30%；n = 12）；接受长期NIV者的为17%（IQR，10%-23%；n = 30）（P = .3）。

interpretation

Our research shows that DTF should be used with caution in children because it does not seem to have a strong correlation with measures of respiratory effort and does not reliably predict SBT or extubation outcomes.

我们的研究表明，在儿童中应谨慎使用DTF，因为它似乎与呼吸努力的测量指标没有强相关性，并且无法可靠地预测SBT或拔管结果。