Diaphragmatic ultrasound could predict extubation success
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Source: criticalecho.com Diaphragmatic Ultrasonography to Assess Readiness for Extubation By Muhammad Adrish, MD Weaning a patient from mechanical ventilation is a challenge that intensivists face routinely. Clinical examination and objective measurements like minute ventilation, respiratory rate, maximal inspiratory pressure, and ratio of respiratory rate to tidal volume have all been used with varying reported sensitivity and specificity for extubation success. However, none of these parameters have shown a clear independent ability to identify patients with adequate respiratory pump function -- i.e., ready for extubation -- with certainty. Waiting too long to extubate poses risks of ventilator acquired pneumonia and neuromuscular complications; extubating patients who aren't ready exposes them to the risk of aspiration or emergent reintubation. Under ideal circumstances, up to 15-20% patients believed ready nonetheless fail extubation and require re-intubation. Re-intubation is associated with prolonged ICU stay, need for transfer to a long-term care facility as well as independently associated with mortality in up to 10-40% of these patients (although it's not clear that extubating too early, as opposed to underlying illness, causes these complications). There remains a strong need for more accurate tools to predict successful weaning from mechanical ventilation. DiNino and colleagues addressed this dilemma by using direct ultrasonographic guided measurement of diaphragmatic function. In a study of 63 patients at two centers, identified by treating intensivists as ready to undergo a pressure support or spontaneous breathing trial, diaphragmatic thickness was measured at its apposition with the rib cage, using a linear ultrasound probe at both end inspiration and end expiration. This information was then used to calculate percent change in diaphragmatic thickness taken over 3-5 breaths. The diaphragm should increase in thickness during inspiration; in healthy spontaneously breathing patients, it may
Diaphragmatic ultrasound could predict extubation success
Diaphragmatic ultrasound could predict…
Diaphragmatic ultrasound could predict extubation success
Source: criticalecho.com Diaphragmatic Ultrasonography to Assess Readiness for Extubation By Muhammad Adrish, MD Weaning a patient from mechanical ventilation is a challenge that intensivists face routinely. Clinical examination and objective measurements like minute ventilation, respiratory rate, maximal inspiratory pressure, and ratio of respiratory rate to tidal volume have all been used with varying reported sensitivity and specificity for extubation success. However, none of these parameters have shown a clear independent ability to identify patients with adequate respiratory pump function -- i.e., ready for extubation -- with certainty. Waiting too long to extubate poses risks of ventilator acquired pneumonia and neuromuscular complications; extubating patients who aren't ready exposes them to the risk of aspiration or emergent reintubation. Under ideal circumstances, up to 15-20% patients believed ready nonetheless fail extubation and require re-intubation. Re-intubation is associated with prolonged ICU stay, need for transfer to a long-term care facility as well as independently associated with mortality in up to 10-40% of these patients (although it's not clear that extubating too early, as opposed to underlying illness, causes these complications). There remains a strong need for more accurate tools to predict successful weaning from mechanical ventilation. DiNino and colleagues addressed this dilemma by using direct ultrasonographic guided measurement of diaphragmatic function. In a study of 63 patients at two centers, identified by treating intensivists as ready to undergo a pressure support or spontaneous breathing trial, diaphragmatic thickness was measured at its apposition with the rib cage, using a linear ultrasound probe at both end inspiration and end expiration. This information was then used to calculate percent change in diaphragmatic thickness taken over 3-5 breaths. The diaphragm should increase in thickness during inspiration; in healthy spontaneously breathing patients, it may