الفهرس 
ContentsOnly 14 pages are availabe for public view
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Abstract
Mechanical ventilation (MV) is a widely used resource within intensive care units (ICUs) for the maintenance of the lives of critically ill patients. Its prolongation is associated with several complications, such as pneumonia, hemodynamic disorders, lung injury and diaphragmatic dysfunction. Weaning failure is due to several factors in patients, but it mainly occurs because it is based on clinical judgments and individualized styles; behaviors that favor the prolongation of MV time. Our longitudinal observational study, adopted ultrasonography to evaluate diaphragmatic function (including thickness, excursion and slope) correlating to weaning outcome. The primary end point was weaning outcome (failed or successful), while the secondary end points included length of ICU stay, weaning duration, ventilation duration, presence or absence of complications and mortality. Two hundred and forty invasively mechanically ventilated patients (138 male & 102 female) aged between 20 years and 78 years were chosen from our respiratory intensive care unit of chest department, Mansoura University Hospital from April 2015 to May 2017. from the 240 patients, 117 (48.8%) had successfully weaned from which 111 patients were with simple weaning and 6 patients were with difficult weaning and 123 (51.2%) patients had failed weaning from which 99 (41.2%) patients were with terminal extubation, 12 patients with re-ventilation, 7 patients with delayed extubation and 5 patients were with tracheastomy. The study has revealed the following important results:Pneumonia was the disease of high percentage in our study (47.5%) followed by mixed diseases (47.1%) then COPD (27.1%). Weaning outcome (failed or successful) and final outcome (survived or died) are affected by APACHE II Score, ICU stay duration and duration of using sedation during stay in respiratory ICU.The sequential sonographic diaphragmatic measurements were statistically significantly high in successful compared to failed group. Sonographic measurements were significantly increased in survived compared to died group. At cut off point 30.105% or more; that predict weaning success, the sensitivity and specificity of percent change of tdi were 100%, 97.4% respectively. At cut off point 1.84 cm or more that predict weaning success, the sensitivity and specificity of diaphragmatic excursion were 100%, 96.4% respectively. At cut off point 0.94 cm/sec or more that predict weaning success, the sensitivity and specificity of diaphragmatic slope were 100%, 94.6% respectively.Conclusion: The measurement of percent change of diaphragmatic thickness was correlated more with weaning outcome with sensitivity (100%) and specificity (97.4%). The sonography based diaphragmatic function score (total score 9) is a valuable tool in determining diaphragmatic function as the three sonography variables; Thickening fraction, excursion and slope, and can be used to predict weaning outcome. Patients achieved diaphragmatic score < 5 have weak diaphragmatic function which predicts weaning failure.