Abstract
OBJECTIVE: This study explores the predictive value of diaphragm ultrasound combined with the Diaphragmatic Rapid Shallow Breathing Index (D-RSBI) in determining weaning outcomes for patients with severe neurological conditions on mechanical ventilation. METHODS: A retrospective analysis was conducted on 128 patients admitted to the Department of Neurosurgery, Chongqing Emergency Medical Center, who required mechanical ventilation. Based on weaning outcomes, patients were categorized into successful (n = 86) and failed (n = 42) weaning groups. We compared diaphragm ultrasound parameters (the main outcome indicators) before weaning, including Diaphragmatic Excursion (DE) Diaphragmatic Thickening Fraction (DTF), D-RSBI (RR/DE), as well as secondary outcome indicators mechanical ventilation time, respiratory rate (RR), and heart rate between the two groups. RESULTS: The results revealed that the traditional RSBI (RR/tidal volume) and D-RSBI in the successful weaning group at the end of mechanical ventilation were lower than those in the failed weaning group, while DE and DTF were higher, the differences between the two groups were statistically significant (p < 0.05). The mechanical ventilation time in the successful weaning group was significantly shorter than that in the failed weaning group, and the difference was statistically significant (p < 0.05). The pre-ventilation respiratory rate and heart rate in the failed weaning group were higher than those in the successful weaning group, and the difference was statistically significant (p < 0.05). Multivariate logistic regression analysis identified high DE and DTF as protective factors, while low D-RSBI was a risk factor for weaning failure (p < 0.05). ROC curve analysis indicated that the combined use of diaphragm ultrasound parameters (DE, DTF) and D-RSBI for predicting successful weaning had an area under the curve (AUC) of 0.887, with 0.895 specificity and 0.862 sensitivity. This combined approach outperformed individual predictors, such as DE (AUC = 0.720), DTF (AUC = 0.786), and D-RSBI (AUC = 0.772). CONCLUSION: In conclusion, diaphragm ultrasound parameters combined with D-RSBI effectively predict weaning outcomes in neurocritical patients on mechanical ventilation. This combined approach shows promising predictive value but requires external validation.