Predictive Value of the Diaphragmatic Rapid Shallow Breathing Index and Its Motion Indicators Combined with Lung Ultrasound Scoring for the Weaning Outcome of Mechanically Ventilated Children

YANG Yuejie; LOU Junge; CUI Zhifei; YAN Yuanyuan

doi:10.3969/j.issn.1004-437X.2025.19.019

Abstract：Objective To explore the predictive value of the diaphragmatic rapid shallow breathing index(D-RSBI)and its motion indicators combined with lung ultrasound scoring(LUS)for the weaning outcome of mechanically ventilated children.Methods One hundred and forty-six children undergoing mechanical ventilation in the intensive care unit(ICU)of Zhengzhou Central Hospital Affiliated to Zhengzhou University from March 2020 to March 2024 were selected.Patients were divided into a successful weaning group(114 cases)and a failed weaning group(32 cases)according to the outcome of weaning.Both groups underwent ultrasound examination within 30 minutes of spontaneous breathing test,and D-RSBI,diaphragmatic excursion(DE),diaphragmatic thickening fraction(DTF),diaphragmatic contraction velocity and LUS were obtained.Pearson correlation analysis was used to analyze the correlation between diaphragmatic parameters,LUS and the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score.The relationship between diaphragmatic parameters,LUS,and weaning outcomes was analyzed using partial correlation analysis.The predictive value of diaphragmatic parameters and LUS for weaning outcomes was evaluated using the receiver operating characteristic(ROC)curve.Results The ICU hospitalization duration of children in the weaning failure group was longer than that of the weaning success group,and their respiratory rate and APACHE Ⅱ scores were higher(P＜0.05).The D-RSBI,diaphragmatic contraction velocity,and LUS of children in the weaning failure group were higher than those in the weaning success group,while their DE and DTF were lower(P＜0.05);the results of Pearson correlation analysis showed that D-RSBI,diaphragm contraction speed,and LUS were positively correlated with APACHE Ⅱscore,while DE and DTF were negatively correlated with APACHE Ⅱ score(P＜0.05).The results of partial correlation analysis showed that D-RSBI,DE,DTF,diaphragm contraction speed,LUS were significantly correlated with weaning outcomes(P＜0.001).The area under the curve(AUC)for D-RSBI,DE,DTF,diaphragm contraction velocity,and LUS alone and in combination to predict withdrawal outcome were 0.732,0.769,0.748,0.790,0.808,and 0.914,respectively,with the highest in combination.Conclusion D-RSBI,DE,DTF,diaphragmatic contraction speed,LUS are related to the severity of the condition and weaning outcome in children with mechanical ventilation,and each parameter can be used to evaluate the weaning outcome in children with mechanical ventilation.