Anesthesia & Clinical Research
Open Access

Abstract

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.