Predictive Value of Diaphragmatic Ultrasound- Based Weaning Indices Compared to Rapid Shallow Breathing Index for Weaning of Mechanically Ventilated Critically-Ill Patients

Background: Aspiration, atelectasis, and pneumonia are among the unfavorable effects and high death rates associated with extubation failure. As a result, extubation cannot proceed without first ensuring an independent, spontaneous breathing trial(SBT). Aim and objectives: The present study aimed to determine whether diaphragm excursion(DE) and diaphragm thickening fraction(DTF) could predict the standard rapid shallow breathing index(RSBI) in critically ill patients on mechanical ventilation. This was done to determine whether extubation was adequate and whether re-intubation was needed. Patients and methods: This prospective study involved 72 severely ill patients in intensive care units(ICUs) of the hospitals affiliated with the Faculty of Medicine Al-Azhar University who required mechanical ventilation. Group A included 36 patients who had diaphragmatic ultrasound evaluation, DE, and DTF. Additionally, 36 patients in Group B were evaluated using the RSBI to forecast whether or not extubation would be successful. Results: It is important to note that the mean DE(mm) in group A is significantly different from group B(p=0.001) after successful extubation: 11.92, while in group A, after failed extubation, it was 8.5. An essential difference between the two groups was found statistically(p=0.005): the mean DTF(%) in group A for successful extubation was 21.42, and it was 13.4% in group A for failed extubation. Conclusion: Diaphragmatic ultrasound assessment had significantly shorter durations of mechanical ventilation than RSBI assessment. In addition, diaphragmatic ultrasound assessment had significantly higher successful extubation rates than RSBI assessment. Moreover, DE&DTF can predict extubation success with higher sensitivity and specificity than RSBI.