Analysis of the Value of Multiparameter Diaphragm and Intercostal Muscle Ultrasound Monitoring in Predicting Weaning Outcomes in Elderly Neurocritical Patients：study protocol for a prospective trial

Abstract

Background:The weaning process for elderly neurocritical patients is complex, with a high reintubation rate. Exploring accurate and effective weaning assessment methods to determine the optimal timing for weaning is of great significance for improving adverse outcomes in these patients. Studies have found that increased activity of accessory respiratory muscles is a compensatory mechanism when diaphragm dysfunction occurs. Therefore, building on traditional diaphragm ultrasound assessments, combining intercostal muscle ultrasound evaluations may improve the accuracy of predicting weaning outcomes in mechanically ventilated patients.

Methods:Mechanically ventilated neurocritical patients admitted to the ICU, EICU, and HDU of our hospital from January 2021 to June 2025 were selected. Patients were divided into a successful weaning group and a failed weaning group based on the final weaning outcome. Diaphragm and intercostal muscle ultrasound measurements were performed on the 2nd, 3rd, 4th, and 5th days of mechanical ventilation, at 30 minutes during the spontaneous breathing trial (SBT), and 2 hours after extubation. The evaluated parameters included: Tdiins, Tdiexp, DTF, DE, D-RSBI, Ticins, Ticexp, TFic, and TFic/DTF. Data analysis was conducted using R language (version 4.2.3) to determine the cutoff values of each parameter for predicting successful weaning and to identify the optimal parameter by comparing AUC values.

Discussion: This study innovatively applies multiparameter intercostal muscle ultrasound combined with diaphragm ultrasound to assess weaning in high-risk patients with diaphragm dysfunction. By observing multiple diaphragm and intercostal muscle ultrasound parameters over time, a multiparameter monitoring system was preliminarily established. This system not only validates the changes in diaphragm and intercostal muscle function over prolonged mechanical ventilation but also significantly improves the accuracy of predicting weaning success, providing clinicians with a comprehensive assessment of respiratory function in elderly neurocritical patients. Additionally, this multiparameter monitoring method facilitates early identification of patients at high risk of reintubation and allows for timely adjustments to treatment plans based on changes in diaphragm and intercostal muscle function, paving a new path for individualized treatment of neurocritical patients.