14: Ultrasonography of the diaphragm to predict successful extubation

Abstract

Background and Aims:Successful weaning from mechanical ventilation and extubation is always a challenge to an intensivist because, both prolonged ventilation and premature extubation are associated with various complications. Prolonged mechanical ventilation is associated with complications such as ventilation associated pneumonia, barotrauma, and atrophy of respiratory muscles.Premature extubation can result in hypoxia, hypercarbia and increased respiratory and cardiac distress. For optimal functioning of the diaphragm, the primary muscle of inspiration, it is important to resume spontaneous ventilation after extubation irrespective of the cause for respiratory failure.Currently, ultrasonography measurement has been studied to predict the success of extubation along with other standard extubation protocols. The study objectives were :1. To measure the diaphragmatic thickening fraction (dTF) and diaphragmatic excursion (DE) before and after spontaneous breathing trial (SBT).2.To compare dTF and DE with standard extubation criteria in predicting extubation outcome.Methods:This was a prospective, double blind observational study. Number of patients was 41. Informed consent was taken from the patients’ attenders..Results:We observed that 68% of the patients with normal dTF and DE values were extubated successfully, 19% were still extubated successfully with slightly lower values of dTF and DE and 9% of patients were reintubated with normal dTF and DE values.Conclusion:We concluded that 68% of cases for dTF>35% and DE >1cm were successfully extubated along with standard parameters.ObservationPrior to PSPrior to extubationDifference t P 1st - DE1.68±0.411.81±0.27-0.127-2.4580.018*2nd - DE1.61±0.311.84±0.30-0.225-0.6630.5113rd - DE1.61±0.351.85±0.27-0.2354.575<0.001**Average - DE1.63±0.331.83±0.26-0.1971.6570.1051st - dTF57.30±26.0262.86±24.71-5.561-1.4080.1672nd - dTF57.00±19.8662.67±18.52-5.676-1.8500.072+3rd - dTF55.52±21.9666.22±17.14-10.700-3.7420.001**Average - dTF54.96±17.9463.87±17.70-8.908-3.7180.001**