Ultrasonographic Evaluation of Diaphragmatic Thickness Versus Excursion as a Predictor of Weaning in Mechanically Ventilated Patients

Abstract

The appropriate timing of extubation is crucial in critically ill patients who are weaned from invasive mechanical ventilation. Early extubation causes post-extubation respiratory failure that result in reintubation and poor outcomes. Delayed extubation can lead to further complications like (VAP) ventilator associated pneumonia and diaphragmatic dysfunction that cause weaning failure from mechanical ventilation. Therefore, deciding the appropriate time for extubation remains a challenge to intensivists who care for critically ill patients. The diaphragm is subjected to various adverse factors in critical patients, such as hypoxia, sepsis, electrolyte imbalance, and neuromuscular blocking agents in addition to mechanical ventilation, which causes ventilator-induced diaphragmatic dysfunction by decreasing the force-generating capacity of diaphragm, therefore the assessment of diaphragm dysfunction is important in patients subjected to weaning or extubation trial as the diaphragm is the primary muscle of inspiration used for spontaneous breathing because it contributes to 70% of the tidal volume during inspiration in normal people.