ULTRASONOGRAPHY OF THE DIAPHRAGM TO PREDICT SUCCESSFUL EXTUBATION

Abstract

INTRODUCTION An intensivist's job has never been easy when it comes to weaning off mechanical ventilation and extubation because both prolonged ventilation and early extubation are linked to a myriad of issues. Prolonged mechanical ventilation is associated with complications such as ventilatory associated pneumonia, barotrauma, atrophy of respiratory muscles. Premature extubation can result in hypoxia, hypercarbia and increased respiratory and cardiac distress. For optimal functioning of the diaphragm, the primary muscle of inspiration, it is important to resume spontaneous ventilation after extubation irrespective of the cause for respiratory failure. Currently ultrasonography measurement has been studied to predict the success of extubation along with other standard extubation protocols. OBJECTIVES OF THE STUDY 1. To measure the diaphragmatic thickening fraction (dTF) and diaphragmatic excursion (DE) before and after spontaneous breathing trial (SBT). 2.To compare dTF and DE with standard extubation criteria in predicting extubation outcome. 21 MATERIALS AND METHODS: This is a prospective, double blind observational study.  Number of patients were 41  Informed consent was taken from the patient’s attenders RESULT: We observed that 68.29% of the patients with normal dTF and DE values were extubated successfully, 21.95% were still extubated successfully with slightly lower values of dTF and DE and 7.31% of patients were reintubated with normal dTF and DE values,2.43% was extubated onto NIV. CONCLUSION: In this study we concluded that in 68.29% of cases for dTF>35% and DE >1cm were successfully extubated along with standard parameters.