Bedside Diaphragmatic Ultrasonography as a Predictor of Successful Weaning from Mechanical Ventilation

Abstract

Objective: To assess the predictive value of diaphragmatic ultrasound for successful weaning from mechanical ventilation.

Methodology: This cross-sectional validation study was conducted in the ICU at PIMS from November 2023 to April 2024, on mechanically ventilated patients aged 16–60 years with a pre-illness frailty score of <3 who met weaning criteria. After a successful 1-hour spontaneous breathing trial (SBT), the Rapid Shallow Breathing Index (RSBI) was recorded, and diaphragm ultrasound was performed by an independent anesthetist to measure diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF). Ultrasound assessments were done using curvilinear and linear probes in a semi-recumbent position. Maintaining the spontaneous breathing for 48 hours post-extubation was defined as successful weaning, while failure was defined as needing re-intubation within 48 hours. Data were analyzed using SPSS version 26.

Results: Overall average age of patients was 37.82 years. There were 19 (28.8%) females and 47(71.2%) males. Mean days on mechanical ventilator was 5.48 days. The outcomes of weaning showed that 59 participants (89.4%) were successfully weaned, while 7 participants (10.6%) experienced failure in the weaning process. Further analysis of outcomes of weaning showed insignificant association with the gender and (P>0.05).

Conclusion: Diaphragmatic ultrasound provided a comprehensive assessment of diaphragmatic function and its role in predicting weaning outcomes. The high success rate suggests that diaphragmatic ultrasound could be a valuable tool in clinical practice for identifying patients who are likely to be successfully weaned from mechanical ventilation, thereby improving patient management and outcomes.