by Rui Zhang,
Xiaoting Xu, Hui Chen, Jennifer Beck, Christer Sinderby, Haibo Qiu, Yi Yang and
Ling Liu
Annals of
Intensive Care volume 13,
Article number: 122 (2023) Published: 06
December 2023
Background
The unsuccessful extubation in patients with traumatic
cervical spinal cord injuries (CSCI) may result from impairment diaphragm
function and monitoring of diaphragm electrical activity (EAdi) can be
informative in guiding extubation. We aimed to evaluate whether the change of
EAdi during a single maximal maneuver can predict extubation outcomes in CSCI
patients.
Methods
This is a retrospective study of CSCI patients requiring
mechanical ventilation in the ICU of a tertiary hospital. A single maximal
maneuver was performed by asking each patient to inhale with maximum strength
during the first spontaneous breathing trial (SBT). The baseline (during SBT
before maximal maneuver), maximum (during the single maximal maneuver), and the
increase of EAdi (ΔEAdi, equal to the difference between baseline and maximal)
were measured. The primary outcome was extubation success, defined as no
reintubation after the first extubation and no tracheostomy before any
extubation during the ICU stay.
Results
Among 107 patients enrolled, 50 (46.7%) were extubated
successfully at the first SBT. Baseline EAdi, maximum EAdi, and ΔEAdi were
significantly higher, and the rapid shallow breathing index was lower in
patients who were extubated successfully than in those who failed. By
multivariable logistic analysis, ΔEAdi was independently associated with
successful extubation (OR 2.03, 95% CI 1.52–3.17). ΔEAdi demonstrated high
diagnostic accuracy in predicting extubation success with an AUROC 0.978 (95%
CI 0.941–0.995), and the cut-off value was 7.0 μV.
Conclusions
The increase of EAdi from baseline SBT during a single
maximal maneuver is associated with successful extubation and can help guide
extubation in CSCI patients.
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