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Critical Care: Ultrasound in the ICU |

Serial Lung and Diaphragm Ultrasonography to Predict Successful Discontinuation of Mechanical Ventilation

Atul Palkar, MBBS; Rivkah Darabaner, MD; Karan Singh, MBBS; Anup Singh, MBBS; Meredith Akerman, MS; Paul Mayo, MD; Eric Gottesman, MD
Author and Funding Information

Hofstra-Northwell Health System, Manhasset, NY


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4_S):465A. doi:10.1016/j.chest.2016.08.478
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Extract

SESSION TITLE: Ultrasound in the ICU

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 04:30 PM - 05:30 PM

PURPOSE: This study seeks to evaluate the performance of serial bedside ultrasonography to assess lung aeration and diaphragmatic function during weaning from mechanical ventilation (MV).

METHODS: Study subjects were patients in the medical intensive care unit who required endotracheal intubation with MV and who were under consideration for extubation. When the patient was ready for extubation as per standard clinical criteria, bedside ultrasonography was performed on three occasions: (1) on assist control mode with consistent ventilator triggering (2) following spontaneous breathing trial (SBT) for 30 minutes (CPAP 5cmH2O/PS 5cmH2O) (3) 4-24 hours after extubation. Ultrasonography was used to assess lung aeration pattern in 8 predefined thoracic regions, and to measure diaphragm thickness fraction (calculated as percentage from: thickness at end inspiration − thickness at end expiration / thickness at end expiration), diaphragm excursion, and diaphragm contraction velocity. Failure of weaning from mechanical ventilation was defined as either the need for non-invasive ventilation or re-intubation within 48 hours of extubation. The success of removal from mechanical ventilation was co-related with the above measurements using the Mann-Whitney test.

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