• Julio E González-Aguirre, Claudia Paola Rivera-Uribe, Erick Joel Rendón-Ramírez, Rogelio Cañamar-Lomas, Juan Antonio Serna-Rodríguez, and Roberto Mercado-Longoría.
• Department of Pulmonary and Critical Care Medicine, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, Mexico. Electronic address: jeglza111@gmail.com.
• Arch. Bronconeumol. 2019 Apr 1; 55 (4): 195-200.

IntroductionInvasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT).MethodsWe prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration - diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure.ResultsEighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.52-0.80] and 0.81 [0.70-0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33-14.98], P<.001).ConclusionIn patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound.Copyright © 2018 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

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