Journal d'anesthésiologie clinique : accès libre

Ultrasound assessment of heart, lung and diaphragm as a predictor of weaning outcome from mechanical ventilation

Abstract

Nagwa Mohammed Doha, Hatem Amin Attalla, Mohamed Shawky Abdullah, Ahmed Mokhtar Elkersh, Walaa Samy Mokhtar and Sadik Abdel Maseeh Sadik

Background: Mechanical ventilating was an essential life supporting method for crucially ill cases. The weaning outcomes influences the morbidities and mortalities of cases when their main disorder advances.

Aim and objectives: To evaluate the predictive value of heart, lung and diaphragmatic US in the process of weaning in mechanically ventilated patients over 48 hours.

Methods: This is a prospective observational single group research which was performed at Menoufia University hospitals between (May 2019 and May 2020).  The study included 62 mechanically ventilated patients over 48 hours fulfilling weaning criteria underwent one Hour Spontaneous Breathing Trail (SBT). Before extubating, data collection comprised US evaluation of LVEF, LVDF was assessed using Left Atrial Area (LAA), early diastolic transmitral flowing velocity wave (E), late diastolic transmitral flow velocity wave (A), early diastolic mitral annulus velocity E′ (average septal and lateral E′), E/A, E de-acceleration time, E/E′, lungs losing of ventilation scoring and diaphragmatic movements./

Results: A high significant relation was found among weaning and LVEF, E’, E/E’ and LAA (p< 0.001) and statistically significant relation between weaning and E/A.Using aeration score it was shown that above 15.5, it can predict failure of weaning with Area Under Curve (AUC) of 0.781. Using diaphragmatic dysfunction, it was shown that if there were full diaphragmatic dysfunction, it can predict failure of weaning with AUC of 0.639.

Conclusion: The US characteristics of heart, lung, and diaphragm providing serious information around cardio-pulmonary and diaphragmatic job throughout SBT. Unsuccessful weaning was more predominant if markers of left ventricular diastolic dysfunctions, increased Lung aeration score and diaphragmatic dysfunction were present.