Diaphragm Ultrasound in Weaning From Mechanical Ventilation
Diaphragm Ultrasound in Weaning From Mechanical Ventilation
This study aims to evaluate the efficacy of ultrasound derived variables in prediction of
 success of weaning from mechanical ventilation in critically ill patients with abdominal
 sepsis
Difficult weaning from mechanical ventilation (MV) is a common problem in critically ill
 patients. Many parameters have been developed to aid weaning from MV such as P/F ratio
 (PO2/FiO2) and rapid shallow breathing index (respiratory rate/tidal volume); however,
 sensitivity and specificity for most variables are still variable in literature.

 Diaphragmatic dysfunction is a common cause of weaning failure (2) however most of the
 traditional methods used for evaluation of diaphragmatic function (fluoroscopy,
 trans-diaphragmatic pressure measurement) are invasive and not available.

 Ultrasound assessment of diaphragmatic function has been developed recently providing an easy
 and safe method for evaluation of diaphragmatic excursion and thickening. In this study we
 will evaluate the ability of the diaphragmatic function to predict weaning success in
 patients with abdominal sepsis.

 After weaning, patients will be divided into two groups; group of successful weaning (group
 S) and group with failed weaning (group F) both groups will be compared as regards all
 clinical, laboratory, and ultrasonographic parameters recorded before weaning, further
 analysis will be done for patients with repeated trials of weaning (more than one trial or
 more than one week MV) and those with simple weaning (first time for weaning).

 A 7-10 Mega Hertz linear ultrasound probe (Mindray machine) set to B mode, the diaphragm will
 be visualized by placing the transducer perpendicular to the chest wall, in the eighth or
 ninth intercostal space, between the anterior axillary and the midaxillary lines, to observe
 the zone of apposition of the muscle 0.5 to 2 cm below the costophrenic sinus.

 The diaphragm thickness will be measured from the middle of the pleural line to the middle of
 the peritoneal line. Then, the diaphragmatic fraction thickening (DTF) will be calculated as
 percentage Diaphragmatic movement will be measured in all patients with a 3.5 Mega Hertz US
 probe placed over one of the lower intercostal spaces in the right anterior axillary line for
 the right diaphragm and the left midaxillary line for the left diaphragm.
Inclusion Criteria:

 -  Critically ill patients with abdominal sepsis with history of MV for more than 48
 hours

 Exclusion Criteria:

 -  Age < 18 years and surgical dressings over the right lower rib cage which would
 preclude ultrasound examination will be excluded. Also, patients with chest trauma,
 thoracotomy, diaphragmatic paralysis, diaphragmatic dysfunction, diaphragmatic injury,
 diaphragmatic surgery and patients with neuromuscular diseases