The application value of cardiopulmonary ultrasound in distinguishing cardiogenic weaning failure in ICU mechani-cally ventilated patients

Liu Yi; Zhao Haotian; Liu Yuanlin; Wang Xiaona; Xue Hongyuan; Li Li; Long Ling

doi:10.3969/j.issn.1671-6450.2023.12.008

Abstract：Objective To explore the application value of cardiopulmonary ultrasound indicators and weaning car-diopulmonary ultrasound scores in distinguishing cardiogenic factors of weaning failure in severe mechanical ventilation pa-tients.Method Four-eight patients who underwent mechanical ventilation at the Intensive Care Unit(ICU)of Hebei Provin-cial People's Hospital from July 2019 to May 2021 and experienced weaning failure were selected.According to the age strat-ification threshold of N-terminal B-type natriuretic peptide precursor(NT proBNP),weaning failure patients were divided into a cardiogenic weaning failure group(cardiogenic group)of 22 cases and a non cardiogenic weaning failure group(non car-diogenic group)of 26 cases.At the beginning of the weaning trial(0 min),bedside ultrasound was used to measure the pa-tient's right ventricular end diastolic diameter(RVEDD),left ventricular end diastolic diameter(LVEDD),left ventricular ejec-tion fraction(LVEF),inferior vena cava diameter(IVCD),early diastolic blood flow peak velocity(E)of the mitral valve,and early diastolic tissue velocity(e')of the mitral annulus/left ventricular sidewall,and E/e'was calculated.At the 0th and 15th minutes of the withdrawal test,lung ultrasound was used to observe the changes in the number of B-lines in the anterior chest wall of both lungs,and each indicator was converted into a binary variable.Using a binary logistic regression model to screen for independent influencing factors.According to partial regression coefficients β Value is used as a weight to as-sign a score.Use the total score as the withdrawal cardiopulmonary ultrasound score.Use ROC curves to evaluate the pre-dictive value of each parameter.Results The proportion of LVEF＜50％,E/e'＞14,IVCD ≥20 mm,and an increase of ≥6 B-lines in pulmonary ultrasound in the cardiogenic group were higher than those in the non cardiogenic group(x/P=11.679/0.001,16.121/＜0.001,11.679/0.001,13.890/＜0.001);Logistic regression analysis showed that LVEF＜50％,E/e'＞14,and an increase of ≥ 6 B-lines in pulmonary ultrasound were independent risk factors for cardiac factor weaning failure[OR(95％CI)=21.119(1.411-316.056),18.119(1.089-46.615),7.126(2.839-115.642)];ROC curve analysis showed that the area under the curve(AUC)for predicting cardiogenic factors of weaning failure by weaning cardiopulmonary ultrasound score was 0.913,which was higher than that predicted by LVEF and IVCD alone(Z/P=0.015/0.044,2.352/0.019),and there was no statistically significant difference in predicting changes in E/e and the number of pulmonary ultrasound B-lines(Z/P=0.928/0353,1.558/0.119).Conclusion Cardiopulmonary ultrasound technology has high application value in identif-ying withdrawal failures caused by cardiogenic factors,with the highest predictive value of withdrawal cardiopulmonary ul-trasound scores.