Ultrasound-Based Abdominal Muscles And Diaphragm Assessment In Predicting Extubation Failure In Patients With Neurointensive Care: A Single-Center Observational Study

Background: Extubation in patients with neurocritical care has high rate of failure. Ineffective cough was the variable independently associated with extubation failure, but its quantification remains challenging. Methods: Patients with primary central nervous system injury under invasive mechanical ventilation (IMV) were included. After a successful spontaneous breathing trial (SBT), abdominal muscles and diaphragm ultrasound was performed under tidal breathing and coughing. Results: we recruited 98 patients who were receiving IMV and 40 patients were included. Extubation failure occurred in 8 (20%) patients. Rectus abdominis (RA) and internal oblique (IO) muscle showed significantly difference regarding cough thickness (T) and cough thickening fraction (TF) between the extubation success and failure group (P<0.05). The logistic regression analysis suggested cough TFRA, cough TFIO and cough TIOwere the factors associated with extubation outcome (P<0.05). In the receiver operating characteristic analysis, cough TFIO exhibited the strongest predictive value (AUC=0.957, 95% CI:0.8979–1). A threshold of cough TFIO≥34.15% predicted extubation success with a sensitivity of 93.8% and a specificity of 75%. Conclusion: Abdominal muscles ultrasound was a promising tool to predict extubation for neurocritical care patients. Trial registration: The study was registered on Chinese Clinical Trial Registry: ChiCTR2400088210, Registered 13 August 2024 - Retrospectively registered，https://www.chictr.org.cn/bin/project/edit?pid=234150