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Clinical Investigations in Critical Care |

Ultrasonographic Evaluation of Liver/Spleen Movements and Extubation Outcome*

Jung-Rern Jiang, MD; Tzu-Hsiu Tsai, MD; Jih-Shuin Jerng, MD; Chong-Jen Yu, MD, PhD; Huey-Dong Wu, MD, FCCP; Pan-Chyr Yang, MD, PhD, FCCP
Author and Funding Information

*From the Department of Internal Medicine (Dr. Jiang), Department of Health Yun-Lin Hospital, Executive Yuan, Taiwan; and Department of Internal Medicine (Drs. Tsai, Jerng, Yu, Wu, and Yang), National Taiwan University Hospital, Taipei, Taiwan.

Correspondence to: Jih-Shuin Jerng, MD, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan; e-mail: jsjerng@ntumc.org



Chest. 2004;126(1):179-185. doi:10.1378/chest.126.1.179
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Introduction: The diaphragm plays a pivotal role in weaning and successful extubation. We hypothesized that ultrasonographic evaluation of the movements of the diaphragm by measuring liver/spleen displacement during spontaneous breathing trials is a good predictor for extubation outcome.

Patients and methods: The studied subjects were intubated patients receiving mechanical ventilation who were scheduled to be extubated. The displacement of liver/spleen was measured by ultrasonography before extubation. The patients were classified into a success group (SG) or failure group according to the extubation outcome. The baseline data and organ displacements in these two groups were analyzed. The sensitivity and specificity for the mean organ displacements and weaning parameters to predict successful extubation were calculated.

Results: We included 55 patients, 32 of whom (58%) were in the SG. The baseline data are similar for these two groups, but the mean values of liver and spleen displacements were higher in the SG. Using a cutoff value of 1.1 cm, the sensitivity and specificity to predict successful extubation were 84.4% and 82.6%, respectively, better than traditional weaning parameters in this study.

Conclusion: The displacement of the liver/spleen, measured by ultrasonography, is a good predictor for extubation outcome.

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