• Do Sik Moon, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, and Chae-Man Lim.
• Department of Pulmonology and Critical Care Medicine, Chosun Universitiy Hospital, Gwangju, Republic of Korea.
• J Crit Care. 2021 Oct 1; 65: 186-191.

PurposeThis study aimed to investigate dynamic changes of lung aeration during a spontaneous breathing trial (SBT) in patients with diaphragm dysfunction (DD) and to predict weaning failure using electrical impedance tomography (EIT).Materials And MethodsWe enrolled 40 adult patients who received mechanical ventilation over 48 h and were eligible for SBT with a T-piece. All patients were screened for DD using ultrasonography before SBT. EIT data, including global inhomogeneity index (an off-site parameter), and temporal skew of aeration (TSA) (an on-site parameter) were collected.ResultsSixteen (40%) patients had DD. During SBT, the tidal impedance variation decreased by 32% from baseline in patients with DD and by 14% in those without DD (p = 0.001). The global inhomogeneity index in the SBT failure group (n = 9) was 0.92 (median), and that of the SBT success group was 0.65 (p = 0.004). The TSA along the vertical axis of the lung was 12.0% and 2.0%, respectively (p = 0.001). With a vertical TSA cutoff of ≥4.35%, SBT failure was predicted with a sensitivity of 88.9% and specificity of 96.9% (area under the curve: 0.955).ConclusionDynamic inhomogeneity of aeration along the vertical axis of the lung as assessed using TSA predicts SBT failure regardless of DD.Trial RegistrationThis trial was retrospectively registered at cris.nih.go.kr (identifier: KCT003567; release date February 27, 2019).Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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