The Role of Diaphragmatic Ultrasound as a Predictor of Extubation From Mechanical Ventilation

The Role of Diaphragmatic Ultrasound as a Predictor of Successful Extubation From Mechanical Ventilation in Respiratory Intensive Care Unit

Aim: To evaluate real-time ultrasound in the evaluation of diaphragmatic thickening, thickening fraction and or excursion to predict extubation outcomes. The investigators aimed to compare these parameters with other traditional weaning measures.

The diaphragm is an important respiratory muscle and dysfunction is very common in patients receiving mechanical ventilation. Diaphragm fatigue occurs even in patients who successfully pass the Spontaneous Breathing Test (SBT). Interrupting ventilation too early can lead to increased cardiovascular and respiratory pressure (CO2).retention and hypoxemia with up to 25% of patients requiring reinstitution of ventilator support. Unnecessary delays in liberation from mechanical ventilation also can be deleterious. Complications such as ventilator-associated pneumonia and ventilator-induced diaphragm atrophy can be seen with short periods of mechanical ventilation thereby prolonging mechanical ventilation. As SBT monitoring is insensitive to detect early signs of load-capacity imbalance. The evaluation of the diaphragmatic thickening fraction (DTF) may be also helpful to assess diaphragmatic function and its contribution to respiratory workload. Ultrasound can be used to detect the deflection of the diaphragm, which helps to identify patients with diaphragm dysfunction

Inclusion Criteria:

• Critically ill patients intubated for more than 48 hours who are ready for weaning with the following criteria.

  1. positive end-expiratory pressure (PEEP) ≤ 5 cm H2O.
  2. Fraction of inspired oxygen (FiO2) < 0.5.
  3. respiratory rate (RR) < 30 breaths/min.
  4. rapid shallow breathing index < 105, PaO2/FiO2 > 200.

• Age< 65 years.

Exclusion Criteria:

• Age<18 years.
• Patient with history of plural effusion, trauma to chest and history of mechanical ventilation for < 6 months.
• patient with neuromuscular diseases affect diaphragm .