Relationship between cardiac ultrasound parameters and extubation outcome in AECOPD patients with respiratory failure

doi:10.3877/cma.j.issn.1674-6902.2023.06.011

Abstract

Abstract:

Objective

To investigate the relationship between echocardiographic parameters and the outcome of mechanical ventilation weaning in patients with AECOPD complicated with respiratory failure.

Methods

A total of 64 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by respiratory failure, who underwent invasive mechanical ventilation treatment at the First Affiliated Hospital of Hunan University of Chinese Medicine from April 2020 to April 2023, were included in this study. Medical records of the patients were collected, and cardiovascular and pulmonary ultrasound examinations were performed before extubation. Based on the extubation outcome, the patients were divided into a control group (successful extubation) and an observation group (failed extubation). Risk factors for extubation failure were screened, and the predictive value of cardiac ultrasound parameters for extubation outcome was analyzed.

Results

Out of the 64 patients, 45 (70.31%) were successfully extubated while 19 (29.69%) failed. The observation group had higher Shallow Fast Breathing Index [(92.31±7.81) vs. (78.26±9.63) breaths/min/L], Lung Ultrasound Score [(19.28±3.31) vs. (17.15±3.04) points], and Early Diastolic Mitral Annular Velocity to Early Diastolic Mitral Flow Velocity (V1/V3) [(10.29±1.58) vs. (8.16±1.39)] than the control group (P<0.05). Shallow Fast Breathing Index (OR=3.518, 95%CI: 1.671-7.409), Lung Ultrasound Score (OR=3.688, 95%CI: 1.751-7.766), and V1/V3 (OR=3.651, 95%CI: 1.734-7.689) were identified as risk factors for extubation failure in AECOPD patients with respiratory failure (P<0.05). The sensitivity, specificity, and area under the curve of cardiac ultrasound parameters in predicting extubation failure were 0.813, 0.771, and 0.844, respectively. The mortality rate in the control group was 0.00%, which was significantly lower than the 26.32% in the observation group (P<0.05).

Conclusion

Cardiac ultrasound parameters are associated with the weaning outcome of patients with AECOPD complicated by respiratory failure, and an increase in the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity is associated with an increased risk of weaning failure.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Respiratory failure, Cardiac ultrasound parameters, Withdrawal outcome

Li Li, Lili Xiang, Fei Tou. Relationship between cardiac ultrasound parameters and extubation outcome in AECOPD patients with respiratory failure[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(06): 799-803.

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Figures/Tables 3

References 30

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临床资料	对照组(n＝45)	观察组(n＝19)	χ²/t	P值
APACHE Ⅱ评分(分)	11.78±1.59	11.86±1.64	0.217	0.828
心率(次/min)	91.42±5.34	90.08±5.19	1.101	0.274
呼吸频率(次/min)	22.81±4.53	22.95±4.36	0.136	0.892
pH	7.42±0.09	7.41±0.10	0.393	0.697
HCO₃^－(mmol/L)	26.51±1.17	27.02±1.35	1.521	0.133
PaO₂(mmHg)	88.16±8.52	87.13±7.29	0.546	0.586
PaCO₂(mmHg)	35.72±5.61	34.97±5.34	0.590	0.557
呼吸指数(次/min/L)	78.26±9.63	92.31±7.81	6.662	0.001
肺部超声评分(分)	17.15±3.04	19.28±3.31	2.978	0.004
左心室后壁厚度(mm)	9.25±1.13	9.22±1.28	0.111	0.911
左心室舒张末期室间隔厚度(mm)	9.15±0.91	9.13±0.72	0.101	0.920
左心室舒张末期内径(mm)	40.25±3.61	41.08±3.57	1.004	0.318
左心室收缩末期内径(mm)	30.12±1.19	30.51±1.06	1.468	0.145
V1/V2(cm·s^－1/cm·s^－1)	0.92±0.23	0.87±0.21	0.968	0.335
V1/V3(cm·s^－1/cm·s^－1)	8.16±1.39	10.29±1.58	6.427	0.001
LVEF(%)	53.02±4.19	54.16±4.57	1.156	0.251

临床资料	对照组(n＝45)	观察组(n＝19)	χ²/t	P值
APACHE Ⅱ评分(分)	11.78±1.59	11.86±1.64	0.217	0.828
心率(次/min)	91.42±5.34	90.08±5.19	1.101	0.274
呼吸频率(次/min)	22.81±4.53	22.95±4.36	0.136	0.892
pH	7.42±0.09	7.41±0.10	0.393	0.697
HCO₃^－(mmol/L)	26.51±1.17	27.02±1.35	1.521	0.133
PaO₂(mmHg)	88.16±8.52	87.13±7.29	0.546	0.586
PaCO₂(mmHg)	35.72±5.61	34.97±5.34	0.590	0.557
呼吸指数(次/min/L)	78.26±9.63	92.31±7.81	6.662	0.001
肺部超声评分(分)	17.15±3.04	19.28±3.31	2.978	0.004
左心室后壁厚度(mm)	9.25±1.13	9.22±1.28	0.111	0.911
左心室舒张末期室间隔厚度(mm)	9.15±0.91	9.13±0.72	0.101	0.920
左心室舒张末期内径(mm)	40.25±3.61	41.08±3.57	1.004	0.318
左心室收缩末期内径(mm)	30.12±1.19	30.51±1.06	1.468	0.145
V1/V2(cm·s^－1/cm·s^－1)	0.92±0.23	0.87±0.21	0.968	0.335
V1/V3(cm·s^－1/cm·s^－1)	8.16±1.39	10.29±1.58	6.427	0.001
LVEF(%)	53.02±4.19	54.16±4.57	1.156	0.251

因　素	β	SE	Wald	P值	OR	95%CI
因　素	β	SE	Wald	P值	OR	下限	上限
浅快呼吸指数	1.258	0.609	4.267	0.005	3.518	1.671	7.409
肺部超声评分	1.305	0.642	4.132	0.005	3.688	1.751	7.766
V1/V3	1.295	0.601	4.643	0.005	3.651	1.734	7.689

因　素	β	SE	Wald	P值	OR	95%CI
因　素	β	SE	Wald	P值	OR	下限	上限
浅快呼吸指数	1.258	0.609	4.267	0.005	3.518	1.671	7.409
肺部超声评分	1.305	0.642	4.132	0.005	3.688	1.751	7.766
V1/V3	1.295	0.601	4.643	0.005	3.651	1.734	7.689

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