# The 30-min diaphragm movement change rate for predicting weaning success in severe pneumonia patients requiring invasive ventilation

## TL;DR

A new method using diaphragm movement changes can predict successful weaning from ventilators in severe pneumonia patients better than existing methods.

## Contribution

The study introduces ΔDE30–0 as a novel predictor for weaning success in severe pneumonia patients.

## Key findings

- ΔDE30–0 showed higher predictive accuracy (AUC 0.924) compared to RSBI and RR.
- Failed weaning group had significantly higher ΔDE30–0 values than successful group.
- ΔDE30–0 at a cut-off of 0.209 achieved 86.1% sensitivity and 95.2% specificity.

## Abstract

This study evaluated the 30-min diaphragm excursion change rate (ΔDE30–0) as a novel predictor of weaning success compared to existing parameters in patients with severe pneumonia requiring invasive mechanical ventilation.

This retrospective cohort study enrolled patients with severe pneumonia requiring invasive mechanical ventilation (n = 100). The patients were divided into successful (n = 79) and failed (n = 21) extubation groups. Ultrasound measurements of diaphragm excursion (DE) were performed at baseline (DE0) and 30 min (DE30) during a spontaneous breathing trial. The ratio ΔDE30–0 was calculated as the absolute difference between DE30 and DE0 divided by DE0. Additional parameters including rapid shallow breathing index (Rapid Shallow Breathing Index, RSBI) and respiratory rate (RR) were also assessed. The predictive performance of ΔDE30–0 and other parameters was evaluated using receiver operating characteristic (ROC) curves.

The extubation failure group had significantly higher ΔDE30–0 (0.40 ± 0.20 vs. 0.14 ± 0.12, p < 0.0001), RSBI (59.62 ± 21.77 vs. 47.7 ± 13.6, p = 0.0025), and RR (23.62 ± 2.25 vs. 20.34 ± 2.18, p < 0.0001) compared to the success group. ΔDE30–0 demonstrated the highest predictive performance with an area under the ROC curve of 0.924, sensitivity of 86.1%, and specificity of 95.2% at a cut-off value of 0.209.

ΔDE30–0 is a promising predictor of weaning success in severe pneumonia patients requiring invasive mechanical ventilation. It outperformed existing parameters and demonstrated high predictive accuracy.

Incorporating ΔDE30–0 into weaning protocols may improve decision-making, reduce complications, and optimize outcomes for patients requiring invasive mechanical ventilation due to severe pneumonia. This novel parameter can aid clinicians in identifying suitable candidates for extubation, potentially reducing the risk of weaning failure and associated adverse events.