Assessment of the the parasternal intercostal muscles thickness by the ultrasonography as a weaning predictor of the mechanically ventilated patients

impact of parasternal muscle thickness on the weaning process of the mechanically ventilated patients in ICU

Inclusion Criteria:

Any patient invasively mechanically ventilated at least 24 hours on a pressure support mode who is clinically stable and ready to undergo a spontaneous breathing trial.

All patients will be:

• Alert.
• Afebrile.
• Adequate cough with absence of excessive tracheobronchial secretion.
• Fraction of inspired oxygen (FIO2) of <50%.
• PEEP ≤8 cmH2O.
• PaO2/FiO2 > 150.
• pH ≥7.35 and ≤7.45.
• Respiratory rate (RR) ≤35 breaths/min.
• Hemodynamically stable in the absence of vasopressors.
• Stable metabolic and endocrinal status.
• Euglycemic state.
• Adequate mentation (no sedation or stable neurologic patient).

Exclusion Criteria:

Diaphragmatic paralysis (detected by ultrasonography).Patients&Methods. 6

• Pregnant women.
• Age: >= 18 years.
• Surgical dressings over measurement point which would preclude ultrasound exam.
• Underweight patients (Body mass index <18.5 kg/m2).
• Morbidly obese patient (Body mass index ≥ 40 kg/m2).
• Primary neuro-muscular diseases.
• Central coditions with depressed central respiratory drive (encephalitis, and brainstem haemorrhage/ischaemia).
• Repiratory conditions with reduced pulmonary compliance (interstitial lung disease, pulmonary hemorrhage, and diffuse pulmonary infiltrates) or reduced chest wall compliance (kyphoscoliosis).
• Cardiac conditions with high risk of weaning induced pulmonary edema (congestive heart failure, cyanotic heart diease, pulmonary hypertension, and ischemic heart diease).
• Addict patients.
• Patients with psychiatric disease.

All patients are invasively mechanically ventilated at least 24 hours, and are clinically stable as ready to undergo a spontaneous breathing trial (SBT).