الفهرس 
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Abstract
Difficulty in weaning from mechanical ventilation (MV) is one of the most frequently encountered problems in modern ICUs. An estimated 20% of mechanically ventilated patients face failed extubation (requiring reintubation within 48 h of extubation) (Epstein SK 2002).
A trial of failed extubation induces several detrimental consequences, including cardiorespiratory stress, prolonged ICU stay, and increased mortality (Funk GC et al., 2010).
Another predictive tool, the rapid-shallow breathing index (RSBI) has gained popularity as a more accurate index in predicting success of extubation, but this ability is limited in patients weaned through pressure support (PS) (Jiang JR et al., 2004).
The diaphragm plays a central role in the process of spontaneous ventilation, and it seems that, in patients receiving MV, a properly functioning diaphragm should predict successful weaning. Although the maximal inspiratory pressure is an indirect method of assessing the diaphragm, the more traditional methods of studying diaphragmatic dysfunction include fluoroscopy, phrenic nerve conduction study, and transdiaphragmatic pressure measurement (Ferrari G et al., 2014).
Ultrasound has emerged as a cheap, widely available, free-from-radiation, bed-side tool for assessment of the characteristics of diaphragmatic movement, such as amplitude, force, and velocity of contraction, special patterns of motion, and changes in diaphragmatic thickness during inspiration (Matamis D et al., 2013, Lerolle N et al., 2009).
This study was conducted upon 40 patients admitted to Abbassia chest disease hospital at ICU to evaluate if ultrasound derived measures of diaphragm thickening and diaphragm motion, can be used to predict extubation success or failure.
The diaphragmatic E and DTF measurements were collected for each group and correlated with some selected weaning criteria namely; PaO2, PaCO2, Respiratory rate (RR), maximum inspiratory force (MiP) and Rapid shallow breath index (RSBI).
Results of this study were:
The study was conducted on 40 patients, their ages ranged between 18 years old and 82 years old with a mean age 53 years.31 patients showed success weaning process representing group A (SW) forming 77.5% while 9 patients failed weaning forming 22.5%. and re-intubated after 48 h from the trial representing group B (FW).
There was significant statistical difference before and after weaning in both groups as regarding DE only, p=0.02. (Table 9)
There was positive correlation between DE before weaning and the other parameter after weaning (DE, DT and DTF%), also there was positive correlation between DT before weaning and DE and DT after weaning but there was not any correlation between DTF% before weaning and the other parameter after weaning except DTF% which was positive correlation.(Table 10)
There was a negative correlation between the DE, DT and DTF% before the weaning and DED, DDT and DDTF% respectively, while become positive correlation after weaning.(Table 11)
As regards the relationship between the whole criteria of weaning (TV/ml/kg, Pio2/Fio2, RR/min, MV/L/min, and RSB index) and the DE/cm before and after weaning and DDE/cm, there were a significant positive correlation appeared between TV/ml/kg and DE/cm before weaning; P=0.02, the same significant positive correlation happened between RR/min and DED/cm; P=0.05. Also, SRB index had significant correlation with DT/cm and it was negative in direction before weaning and positive in direction with DDT/cm; P= 0.049 and 0.024 respectively. Finally; there were a significant correlation between the TV/ml/kg and DTF% after weaning and DDTF% and it was positive in direction; P=0.012 and 0.007 respectively.(Table 12)
Conclusion :-
Diaphragmatic ultrasound provide rapid and non invasive indices for weaning process with high accurate results in comparison to the other traditional indices as blood gases and the respiratory mechanics. So, they can be used as predictive parameters to assess the weaning process outcome .
Recommendations:-
-Diaphragmatic ultrasound can be used as predictive parameters to assess the weaning process outcome .
- Prolonged periods of complete diaphragmatic restshould be avoided and diaphragmatic contraction preserved wheneverpossible.
- Respiratory muscle training may lead to improved weaning success.
- Due to the apparent attenuation of the decline in diaphragm thickness seen in patients switched from AC to PS ventilation and increase in diaphragm thickness seen in all other patients following the institution of PS ventilation, it may be reasonable to assume early switch from AC to PS ventilation or even allowing for short controlled periods of spontaneous breathing and addition of PEEP may make the work performed by the diaphragm sufficient to attenuate, reverse or minimize disuse atrophy and thus avoiding difficult, prolonged or failed weaning.