Application value of cardiopulmonary combined diaphragm ultrasound in predicting the weaning from mechanical ventilation in patients of total anomalous pulmonary venous connection(TAPVC) after cardiac surgery in children
10.3760/cma.j.cn112434-20240809-00193
- VernacularTitle:心肺膈肌联合超声在儿童完全型肺静脉异位引流术后机械通气脱机中的临床价值
- Author:
Ying MO
1
;
Qiang WANG
;
Gang LI
;
Wenhong DING
Author Information
1. 首都医科大学附属北京安贞医院 北京市心肺血管疾病研究所小儿心脏中心，北京 100029
- Keywords:
Total anomalous pulmonary venous connection;
Echocardiography;
Lung ultrasound;
Congenital heart disease
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2024;40(10):599-606
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the role of cardiopulmonary combined diaphragm ultrasound in predicting the weaning from mechanical ventilation in patients of total anomalous pulmonary venous connection after cardiac surgery in children.Methods:105 patients with TAPVC after cardiac surgery were included and admitted to Beijing Anzhen Hospital from January 2020 to September 2023, and median age was 6 months, including 61 males and 44 females. Echocardiography was routinely performed before surgery, clinical indicators such as age, weight, sex, cardiopulmonary bypass, activated coagulation time were recorded at the same time. And bedside cardiopulmonary combined diaphragm ultrasound was performed after the patient successfully passed the spontaneous breathing test. Ultrasound measurements include atrial septal defect diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, right ventricular area change fraction, tricuspid annular plane systolic excursion, pulmonary venous diameter, pulmonary ultrasound score, and diaphragm thickening fraction, According to whether the offline was successful, patients were divided into two groups: successful extubation group (78 cases) and extubation failure group (27 cases). The t-test was used for mean comparison. The Mann- Whitney U test was used for median comparison. Pearson χ2 test was used for counting data. Univariate analysis was used to determine the parameters with significant statistical differences in predicted weaning failure, and multivariate logistic regression analysis was included to find independent prediction parameters. The statistical parameters between the two groups were used to draw the receiver operating characteristic curves, and then the ROC curves were comprehensively plotted by the combining indexes. Results:The age, weight, left ventricular diastolic diameter, and atrial septal defect diameter of the the failure group were smaller than those in the weaning group, and the differences were statistically significant ( P<0.05). There were statistically significant differences in cardiopulmonary bypass and activated coagulation time in the weaning failure group ( P<0.05). There were no significant differences in gender and preoperative pulmonary venous flow velocity between the two groups ( P>0.05). Multivariate logistic regression analysis showed that postoperative left ventricular ejection fraction, pulmonary venous flow velocity, and pulmonary ultrasound score diaphragm thickening fraction were significantly correlated with weaning failure ( P<0.05), area under the ROC curve( AUC) were 0.736, 0.761, 0.868 and 0.829( P<0.05), and the optimal cut-off values were 0.50, 160 cm/s, 14 scores and 27% respectively. The AUC of cardiopulmonary combined diaphragm with ultrasound index for predicting weaning failure was 0.966, the sensitivity was 96.3%, and the specificity was 89.9%, which was significantly higher than that of other ultrasound indicators. Conclusion:Bedside cardiopulmonary combined diaphragm ultrasound has important clinical value in predicting ventilator evacuation of patients after total anomalous pulmonary venous connection, and its accuracy is higher than that of single-organ ultrasound.
