Prognostic value of pulmonary ultrasound B-line score combined with diaphragmatic ultrasound in mechanical ventilation withdrawal outcome in children with severe respiratory failure
Objective To investigate the predictive value of lung ultrasound B-line score(LUBS)combined with diaphragm ultrasound in mechanical ventilation withdrawal outcome of severe respiratory failure children.Methods Totally 110 children with severe respiratory failure who received mechanical ventilation were divided into the successful group(83 cases)and failed group(27 cases).Both groups underwent bedside lung ultrasound examination within 30 minutes of the spontaneous breathing test,and LUBS was calculated.Diaphragmatic ultrasound was performed to measure diaphragmatic movement,and diaphragmatic rapid shallow breathing index(D-RSBI)and the change rate of diaphragmatic thickness were calculated.We analyze the predictive value of LUBS and diaphragm ultrasound in the outcome of mechanical ventila-tion withdrawal in children with severe respiratory failure.Results The respiratory rate,APACHEⅡ score,LUBS and D-RSBI in the successful group were lower than those in the failed group,and the diaphragm mobility and diaphragm thick-ness change rate were higher than those in the failed group(all P<0.05).Multivariate Logistic regression analysis showed that LUBS,APACHEⅡ score and D-RSBI were risk factors for withdrawal failure in children with severe respiratory fail-ure,while diaphragm mobility and diaphragm thickness change rate were protective factors(all P<0.05).Pearson correla-tion analysis showed that LUBS was negatively correlated with the degree of diaphragm movement and the change rate of diaphragm thickness in children with severe response failure(r=-0.375,-0.411,respectively;both P<0.05),but was positively correlated with D-RSBI(r=0.526,P<0.05).The receiver operating characteristic curve analysis showed that the area under the curve of LUBS,diaphragm mobility,diaphragm thickness change rate and D-RSBI in predicting with-drawal failure of children with severe respiratory failure was 0.773,0.805,0.848 and 0.808,respectively,and the area under the curve of all indexes combined in predicting withdrawal failure of children with severe respiratory failure was 0.943.Conclusion LUBS combined with diaphragmatic ultrasound has certain predictive value in mechanical ventila-tion withdrawal outcome of patients with severe respiratory failure,and the combination of the two can further improve its predictive value.
severe respiratory failuremechanical ventilationpulmonary ultrasound B line scorediaphragm ultrasoundwithdrawal outcomechildren
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