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365990

The impact of heart, lung and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients.

Article

Last updated: 29 Dec 2024

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Abstract

Background: Weaning failure is defined as failing spontaneous breathing trial or developing post-extubation respiratory distress that requires re-intubation or non-invasive ventilation within 48 h following extubation. Identification of reliable predictors of weaning failure may represent potential avenues of treatment that could reduce the incidence of weaning failure. Known predictors of weaning failure include chronic obstructive airway disease, cardiac failure, positive fluid balance and diaphragmatic dysfunction. Aim: To assess the usefulness of heart, lung & diaphragmatic ultrasound in prediction of weaning failure in critically ill patient and to compare it with conventional predictors of weaning. Patients and Methods: a prospective observational study conducted on 40 critically ill ventilated patients and admitted to the critical care department where heart, lung & diaphragmatic ultrasound were done for adult patients who were intubated and mechanically ventilated for at least 48 hours and ready for weaning according to the readiness criteria. Results: According to weaning outcome in the initial SBT, patients were divided into 2 groups: Successful weaning group (Group A):  included 18 patients who had successful weaning during SBT. Failed weaning group (Group B):   included 22 patients. The failing group had higher B-line score (2.5±0.7 vs. 1.6±0.6), P = 0.002. Successful group had higher diaphragmatic excursion (2±0.4 vs. 1.2±0.5 cm, P <0.001). Diastolic dysfunction more than grade I, could predict weaning failure with sensitivity 100%, specificity 66%, PPV 78% and NPV 100% with an AUC 0.955(0.837-0.995).  Conclusion: Failed weaning in mechanically ventilated patients is more prevalent if markers of LV dysfunction (systolic and diastolic), B line score and reduced diaphragmatic excursion are present. Prediction of weaning failure could be significantly assisted by an integrative, dynamic, and fully bedside ultrasonographic concomitant assessment of the heart and lungs before the start of the weaning process or during SBT.

DOI

10.21608/jicem.2024.365990

Keywords

B-lines, diaphragmatic ultrasound, Diastolic Dysfunction, Weaning Failure

Authors

First Name

Sameh

Last Name

El Maraghi

MiddleName

Kamal

Affiliation

Critical Care Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

Email

sameh_elmaraghi@yahoo.com

City

Cairo

Orcid

0000-0001-5185-6923

First Name

Taha

Last Name

Sayed

MiddleName

Kamal

Affiliation

Critical Care Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

Email

tahakamal160@gmail.com

City

benisuef

Orcid

-

First Name

Mohammed

Last Name

Hamila

MiddleName

Abdelkader

Affiliation

Critical Care Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

Email

hamila@hotmail.com

City

-

Orcid

-

First Name

Khalaf

Last Name

Eldehily

MiddleName

Ibrahim

Affiliation

Critical Care Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

Email

drkhalaf80@yahoo.com

City

-

Orcid

-

Volume

4

Article Issue

2

Related Issue

49025

Issue Date

2024-06-01

Receive Date

2023-11-22

Publish Date

2024-06-01

Page Start

23

Page End

35

Print ISSN

2812-5452

Online ISSN

2812-5460

Link

https://jicem.journals.ekb.eg/article_365990.html

Detail API

https://jicem.journals.ekb.eg/service?article_code=365990

Order

365,990

Type

Original papers

Type Code

2,351

Publication Type

Journal

Publication Title

The Egyptian Journal of Intensive Care and Emergency Medicine

Publication Link

https://jicem.journals.ekb.eg/

MainTitle

The impact of heart, lung and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients.

Details

Type

Article

Created At

29 Dec 2024