Diaphragm Ultrasound as Aid in Successful Extubation from Mechanical Ventilation

Background: Prolonged mechanical ventilation has long imposed significant challenges to the intensivists. While weaning failure is associated with several possible causes, diaphragmatic dysfunction has been found to be a significant contributor to weaning failure in mechanically ventilated patients. Predicting diaphragm function before attempting extubation can serve as a reliable monitoring parameter to predict the success of extubation in such patients. Ultrasound-based diaphragm measurements, particularly diaphragmatic thickness fraction (DTf%), are now emerging as reliable indicators of diaphragmatic function and have been used in predicting the success of extubation. Material and Methods: A prospective observational study conducted in the Surgical ICU of SMHS Hospital from May 2021 to Oct 2022 investigated the predictive value of Diaphragm Thickening Fraction (DTf) on weaning outcomes in 60 mechanically ventilated adults. Inclusion criteria included age ≥ 18, appropriate mental status, respiratory and cardiovascular stability, and no correctable comorbidities. Diaphragmatic measurements were taken via ultrasound, followed by spontaneous breathing trials. Weaning outcome was defined as successful or failed. Statistical analysis using SPSS software identified predictors of successful weaning. Results: This study found significant associations between Diaphragmatic Thickening Fraction (DTf) and extubation outcomes. The majority (75%) had DTf >30%. Successful extubation occurred in 44 (73.3%) patients, with significantly higher DTf values (42.3±9.1 vs 30.3±5.4, p<0.001). Multivariable logistic regression analysis revealed ventilation duration as the only independent predictor of extubation outcome (p<0.005). Other factors, including age, gender, and comorbidities, did not significantly impact extubation success. Conclusion: Our study finds Diaphragmatic Thickening Fraction (DTf) to be a significant predictor of extubation success, assessed through non-invasive, cost-effective ultrasonography. Evaluating DTf enables clinicians to accurately prognosticate extubation outcomes, anticipate reintubation risks, and inform decision-making.

Keywords: Mechanical ventilation, Diaphragm function, Ultrasound, Weaning, Extubation, Diaphragmatic Thickening Fraction (DTf).