Combined Ultrasound Measurements of Diaphragm and Intercostal Muscles in Mechanically Ventilated Patients with Sepsis: A Novel Approach to Optimize Extubation Prediction

Aim To evaluate the efficiency of combined diaphragm and intercostal muscle ultrasound assessment in predicting the extubation outcome in mechanically ventilated patients with sepsis. Methods This study was a prospective observational study of septic patients consecutively admitted to the hospital from October 2022 to October 2023 for mechanical ventilation. During the period when the patients passed the ventilator weaning screening and spontaneous breathing trial (SBT), ultrasound evaluation of the diaphragm and intercostal muscles was performed to measure diaphragm excursion (DE), diaphragm thickening fraction (TFD) and intercostal muscle thickening fraction (TFic). The patients were divided into the successful extubation group (89 cases) and the failed extubation group (15 cases) according to the extubation results. ROC curves were used to analyze the effects of diaphragm ultrasound and intercostal muscle ultrasound alone and in combination to predict extubation outcomes. Results TFic and TFic/TFD values were significantly higher in the failed extubation group than in the successful extubation group during extubation ( P < 0.05). The area under the ROC curve (AUROC) of DE, TFD, and TFic to predict extubation failure in mechanically ventilated patients with sepsis before extubation were 0.689, 0.657, and 0.769, respectively, whereas the combined indexes, such as TFic/TFD and TFic &TFD_mix had AUROCs of 0.867 and 0.860, respectively. TFic/TFD with a cutoff value of >0.95, had a sensitivity of 86.7% and specificity of 75.3% in predicting extubation failure, and TFic &TFD_mix with a cutoff value of >0.13, had a sensitivity of 86.6% and specificity of 80.9% in predicting extubation failure. Conclusion: The combination of diaphragm and intercostal muscle ultrasound assessment might effectively predict the extubation outcome in mechanically ventilated patients with sepsis.