الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Timing is critical when determining if a patient can be successfully extubated. Premature discontinuation of mechanical ventilation may lead to increased cardiovascular and respiratory stress, CO2 retention and hypoxaemia with up to 25% of patients requiring reinstitution of ventilator support. Unnecessary delays in weaning from mechanical ventilation also can be deleterious. Complications such as ventilator associated pneumonia and ventilator induced diaphragm atrophy can be seen with short periods of mechanical ventilation thereby prolonging mechanical ventilation.
Tools available for determining the optimal timing of extubation are limited. Subjective decisions are often wrong. Stroetz and Hubmayr found that clinical prediction of extubation success or failure was often incorrect with the decision to extubate biased toward ventilator dependency.
Measures such as breathing frequency, minute ventilation, and negative inspiratory force, have done little to improve the timing of successful extubation. A more recent parameter, the rapid shallow breathing index (RSBI) provides a guide for timing extubation with spontaneous breathing (SB) trials but its value is limited when used to predict successful extubation during pressure support (PS) trials.
ultrasound has been used to evaluate diaphragmatic function over 40 years. Advantages of ultrasound include safety, avoidance of radiation hazards, and availability at the bedside. It may be used to measure diaphragmatic excursion, the thickening of the diaphragm, and the speed of diaphragmatic contraction.
Summary __________________________________________________________
Among patients requiring mechanical ventilation, detection of diaphragmatic dysfunction by ultrasound performed during spontaneous breathing trial is associated with both longer weaning time and longer total ventilation time. The evaluation of the diaphragmatic thickening fraction (DTF) may be helpful to assess diaphragmatic function and its contribution to respiratory workload.
The study is aimed to evaluate if ultrasound derived measures of diaphragm thickening, and diaphragm motion can be used to predict extubation success or failure in ICU mechanically ventilated patients.
This study is a prospective cross sectional observational study, was carried out at Menoufia University Hospital‘s intensive care unit from April 2020 till October 2020.
The main results of the study revealed that:
Successful Cases included 23 males (82.1 %) and 5 females (17.9 %). Their age ranged from 43.0 to 70.0 years with (mean ±SD 54.61 ± 8.82). Their Time on MV ranged from 2 to 6.0 days with (mean ±SD 3.64 ± 1.54). Their Time SBT- extubation ranged from 30 to 120 minutes with (mean ±SD 90.0 ± 35.38).
Failed Cases included 14 males (63.6 %) and 8 females (36.4 %). Their age ranged from 40.0 to 70.0 years with (mean ±SD 51.77 ± 9.59). Their Time on MV ranged from 3 to 9.0 days with (mean ±SD 5.95 ± 2.01). Their Time SBT- extubation ranged from 30 to 120 minutes with (mean ±SD 75.91 ± 24.23).
there was no statistical significant difference between groups as regard sex, Age (years) and Time SBT- extubation (minutes),
Summary __________________________________________________________
but there was high statistical significant difference between groups as regard Time on MV (days).
there was no statistical significant difference between groups as regard mode of SBT.
there is non-Statistical significant differences between rate of failed and success weaning as regard comorbidities except for chronic heart diseases which was higher among cases with success weaning.
there is non-Statistical significant difference between success and failed weaning as regard pathology at ICU admission.
there is highly Statistical significant difference between success and failed weaning as regard ultrasound findings where p<0.001.
there was no statistical significant difference between groups as regard Tidal volume (ml), FiO2, pH, Lactate (mmol/L) and ICU mortality,
There was statistical significant difference between groups as regard minute volume, Compliance (mL/cm H2O), P0.1 (cm H2O), SpO2, PaCO2 (mm Hg).
Also there was high statistical significant difference between groups as regard Diaphragm thickness index, APACHE II, PIMax (cm H2O), RSBI (breaths/min/L), RR (breaths/min), PaO2 (mm Hg), ICU stay (days) and Hospital stay (days).
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.