Diaphragmatic Excursion Assessment by Ultrasound versus Volume Associated Weaning Parameters as A Prediction in Extubation in Critically Ill Patients

Abstract

Background: Liberating a patient from ventilator is a continuous process as with any disease condition which starts with recognition of patient being ready to be weaned from ventilator by letting the patient breathe on T-piece and, if successful proceeding to SBT followed by extubation, if it is tolerated well (simple weaning). Otherwise letting patient on ventilator till next such trial being successful. Difficulty in weaning from mechanical ventilation is one of the most frequently encountered problems in MICU. An estimated 20% of mechanically ventilated patients face failed extuabtion (requiring reintubation within 48 h of extuabtion). Aim of the study: This study was designed to assess the value of the excursion of diaphragm tested by ultrasonography to predict weaning from mechanical ventilation versus volume associated weaning parameters in medical intensive unit’s patients. Patients and Methods: A prospective study was carried out on 30 patients ready for weaning. All patients were divided into two equal groups.Group A (successful weaning group) and Group B (failed weaning group). Results: Of the entire group of 30 patients, 21 patients (70%) had succeeded extubation and 9 patients (30%) failed. By applying cut-off level 1cm determined in our study the sensitivity and specificity of mean liver and spleen displacement were 95.2% and 88.9% respectively, which is higher than Pi max (85.7% and 77.8%) by cut-off level ≤ 20 cm H2o, ƒ/VT (85.7% and 66.7%) by cut-off level ≤ 105 breath/min/l. Conclusions: The present study concluded that ultrasonographic measurement of liver and spleen displacement during SBT before extubation is a good method for predicting extubation outcome.Ke