الفهرس 
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Abstract
weaning from mechanical ventilation (MV) is one of the most frequently encountered challenges in modern ICUs. An estimated 20% of mechanically ventilated patients face failed extubation (requiring reintubation within 48 h of extubation).[115]
Timing is critical when deciding if a patient can be successfully extubated. Premature discontinuation of mechanical ventilation may lead to increased cardiorespiratory stress, hypoxemia, CO2 retention, reintubation, prolonged ICU stay and increased mortality. [115]
Unnecessary Delay in attempting extubation also increases the likelihood that patients would face the inherent risks of MV, including ventilator-associated pneumonia and ventilator-induced diaphragmatic atrophy. [11]
There are many reasons for failure to establish independent, spontaneous ventilation after a period of ventilator support include oxygenation failure, respiratory muscle dysfunction, psychological dependence, and cardiovascular dysfunction. [11]
Ultrasonography is well established as a useful, cheap, widely available and free-from-radiation, when performed by the intensivist at point of care for evaluation of cardiopulmonary failure. [191]
As ultrasonography is an evolving part of critical care medicine, an interesting feature of the discipline is that it lends itself to innovative applications. [191]
Bedside ultrasonography can be very useful in the evaluation and management of mechanically ventilated patients. In intensive care units the role of ultrasound is not limited to diagnosis but can be used as a guide for management of mechanical ventilation from early stages to weaning. To obtain a comprehensive functional evaluation of critical care patients during mechanical ventilation, chest ultrasonography should include the examinations of the lungs, heart, and diaphragm. [191]
To our knowledge, the present study demonstrates, for the first time, the impact of integrated use of ultrasound in the prediction of weaning outcome.
This study is a prospective observational study conducted on 40 critically ill ventilated patients and admitted to the critical care department of Beni-Suef university hospital in the duration from feburary 2019 to feburary2020
The study protocol was approved by the ethical committee of Beni-Suef University.
Patients ready for weaning were subjected to the study measurements before 30 minutes of initiation of the SBT. Patients were then followed during weaning and 48 hours after successful weaning to detect failed weaning or re-intubation. Patients were then classified into successful and failed weaning groups.
During PPV, clinical, laboratory, ABG and ventilator data were collected. Also, echocardiography, lung, diaphragmatic ultrasonography and were measured. After that, included patients were subjected to a SBT, for 2 hours, using (PSV) with pressure support (5-10 cmH2O)
Objectives of our study were:
To assess the impact of integrated use of echocardiography, lung ultrasound and diaphragm ultrasound as a new tool to determine the optimal timing for weaning and prediction of its outcome
To demonstrate impact of left ventricular systolic and diastolic functions (by echocardiography), diaphragmatic dysfunction (by diaphragm ultrasound) and lung aeriation loss (by lung ultrasound) on weaning outcome.
Receiver operator characteristic(ROC )curve analysis was done using echocardiography, lung and diaphragmatic ultrasound variables as predictors of failure of weaning from mechanical ventilation.
At diaphragmatic excursion less than or equal to 1.3 cm, could predict the failure of weaning with sensitivity 94.5%, specificity 59.1%, PPV % 65.4% and NPV 92.9%
Diastolic dysfunction more than grade I, could predict the failure of weaning with sensitivity 100%, specificity 66 %, PPV 78% and NPV 100
B-line score more than 2, could predict the failure of weaning with sensitivity 94.4%, specificity 86.4%, PPV 77.3% and NPV 95%
Ejection fraction less than or equal 49%, could predict failure of weaning with sensitivity 54.55%, specificity 72.22%, PPV 70.6% and NPV 56.6%.