Ultrasound diaphragmatic assessment to predict weaning outcomes in intensive care unit: a prospective cohort study

Background
Reintubation is required 48–72 h after extubation in 3–19% of patients, which raises ICU morbidity, mortality, and costs. Diaphragm dysfunction frequently results in extubation failure. The diaphragm’s thickness and mobility can be assessed using ultrasonography. This study examined the role of thickening fraction and diaphragm excursion (DE) in predicting weaning success from mechanical ventilation in ICU. This study explores the utility of diaphragmatic ultrasound as an additional parameter in weaning outcome prediction.


Patients and methods
A total of 79 patients were enrolled in this study and received mechanical ventilation. They were divided into two groups according to the success of spontaneous breathing trial (SBT). Diaphragm ultrasound including diaphragmatic excursion (DE) and thickening fraction (DTF) was performed three times: at baseline on admission, before starting invasive mechanical ventilation and during SBT.


Results
Of the 79 included patients, 59% (47) were able to pass SBT and 41% (32) failed extubation. Weaning success was significantly correlated with DE and DTF (P<0.0001). DE cutoff 31.01 mm (±7.38 SD) was associated with successful extubation and a cutoff of 19.66 mm (±2.76 SD) was associated with weaning failure. DTF cutoff 45.81% (±14.58 SD) was significantly correlated with successful passing SBT.


Conclusions
DE and DTF are better indicators of weaning success in addition to other weaning parameters.