SONOGRAPHIC EVALUATION OF THE HEART, LUNG AND DIAPHRAGM DURING WEANING FROM MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS | ||
| Ain Shams Medical Journal | ||
| Article 17, Volume 71, Issue 4, December 2020, Pages 1009-1018 PDF (290.8 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asmj.2020.148959 | ||
| Authors | ||
| Nahed E. Youssef1; Adel M. Alansary1; Adel A. Habib2; Fady N. Guirguis1 | ||
| 1Department of Anesthesia and Intensive Care medicine Faculty of Medicine-Ain Shams University | ||
| 2Intensive Care Registrar at Dar Al Fouad Hospotal, Egypt | ||
| Abstract | ||
| Background: Failure of weaning is a commonly encountered problem that faces intensivists, unfortunately this is a multifactorial condition and includes multiple interplays between cardiac and pulmonary functions. Timing is critical when determining if a patient can be successfully extubated. Premature discontinuation of mechanical ventilation may lead to increased cardiovascular and respiratory stress, CO2 retention and hypoxemia with up to 25% of patients requiring reinstitution of ventilator support. Unnecessary delays in weaning from mechanical ventilation also can be deleterious. Aim of work: To evaluate the value of echo, lung ultrasound and diaphragm ultrasound as a predictor of weaning outcomes compared to clinical weaning criteria. Patients and methods: Fifty patients were involved in the present study. They were admitted in the ICU at a tertiary hospital. They received the conventional measurements for weaning and echo, lung ultrasonography diaphragm ultrasonography during weaning and after extubation. We assessed the TAPSE, EF, E/A ratio, lung score, diaphragm excursion and thickening. All ultrasonography findings were gathered and compared with some of the usual clinical weaning tools such as arterial blood gas and respiratory mechanics. The findings were statistically analyzed. Results:31 patients were successfully weaned from mechanical ventilation according to the study criteria representing 62% and 19 patients failed weaning from mechanical ventilation representing 38%. Lung ultrasound and diaphragm thickening fraction only found to be significantly accurate predictors of weaning success or failure. Conclusion: lung ultrasound score and diaphragm thickening fraction can be used as predictors of weaning outcomes. | ||
| Keywords | ||
| Sonography; heart; lung; diaphragm; mechanical ventilation; critical ill patients; weaning | ||
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