Integrated use of bedside lung, diaphragmatic ultrasound and echocardiography in prediction of weaning failure in mechanically ventilated patients / Soliman Belal Soliman ; Supervised Fahim Abdelazim Ragab , Randa Aly Soliman , Ayman Gaber Sadek

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Failure of weaning from mechanical ventilation(MV) is a common problem that face the intensivist. The causes are often multifactorial and involve a complex interplay between cardiac and pulmonary dysfunction. Application of chest ultrasonography(US) may help in weaning and prediction of its outcome. Methods: 50 invasively MV patients fulfilling criteria of weaning&shifted to SBT(using PSV 8 cmH2O) for 1 hour.Weaning failure was defined as;Failed SBT,Reintubation&/or reventilation or death within 48 hours.Echocardiography was used to get Ejection fraction,E/A ratio,TAPSE,Doppler tissue imaging (DTI)&E`(MV lateral),E`(MV septal),E/E`lateral,E/E` septal, E`(Tricuspid valve)and E/ E`(Tricuspid valve),lung ultrasound(LUS)was used to assess LUS score,diaphragm ultrasound was used to assess diaphragmatic thickening fraction(DTF). Results: Mean age 57.1±14.5, 62% were males.Weaning was successful in 80% of patients. E/A ratio,E/E`(MV lateral),E/ E`(MV Septal),E/ E`(Tricuspid valve),and(LUS) score were significantly higher in the failed weaning group: :(1.5±0.5)versus(1.1±0.4),(p:0.004),(11.5±3.3)versus(7.3±1.6)(p:0.003),(13±3.1)versus(8.0±1.9),(p:0.001),(9.4±1.4)cm vs (6.9±1.3cm),(p:0.001),and(10.8±4.2) vs(16.5±4.2cm),(p:0.001) respectively.E`(MV lateral).E`(MV septal),and (DTF) were significantly higher in the successful weaning group:(10.6±2.4versus(8.4±2.5)(p:0.013), (9.4±2.4)versus(7.0±2.4)(p:0.007)and(43.0±10.7)vs(28.9±2.8cm),(p:0.001)respectively

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