Role of Ultrasound Assessment of Parasternal Intercostal Muscle Thickness During Weaning From Mechanical Ventilation

Role of Ultrasound Assessment of Parasternal Intercostal Muscle Thickness During Weaning From Mechanical Ventilation

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.