Анестезия и клинические исследования
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Value of Integrated Lung and Diaphragm Ultrasonography in Predicting Extubation Outcomes from Mechanical Ventilation in Patients with Critical Illness

Huda Fahmy, Mohamed Saied, Islam Sayed and Sayed Kinawy

Background: A primary priority for all intensivists is identifying strategies to reduce the duration of Mechanical Ventilation (MV) and deciding the ideal time for extubation.

Aim: To evaluate the role of the diaphragm and lung ultrasonography principally (DE, DTF, and LUS scores) in the prediction of extubation outcomes from MV.

Patients and methods: This prospective observational study included sixty-eight adult patients who required invasive MV for as a minimum of 24 hours and successfully passed a spontaneous breathing trial (SBT) were enrolled in our study. At the end of a successful SBT, we assessed by ultrasound DE, DTF and lung parenchyma.

Results: 53 patients (78%) successfully extubated while, 15 patients (22%) experienced failed extubation. DTF% with cutoff value ≥ 30% had the highest sensitivity (100%), negative predictive value (100%) and the highest accuracy (89.24%). On combining DTF% ≥ 30% and LUS ≤ 12, specificity and the diagnostic accuracy raised to (100% and 96% respectively) with highly precise AUC (0.97).

Conclusion: The integration of DTF % ≥ 30% of the right hemi-diaphragm with LUS ≤ 12 improved the expectation of successful extubation in comparison with DTF % alone.