الفهرس 
ANATOMY OF THE CHEST, LUNGOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Background: Failure of extubation of mechanically ventilated patients remains one of the challenges in the intensive care unit (ICU). It’s defined as the necessity to reintubate the patient 24-72 hrs following extubation and up to 7 days. The incidence of failed extubation varies in literature ranging from 5-47%. Failed extubation is responsible for prolonged mechanical ventilation which in turn leads to many complications including Ventilator associated pneumonia (VAP), Ventilator-Induced Lung Injury (VILI). Cardiopulmonary complications, upper airway complications (laryngeal & tracheal) and ventilator induced diaphragmatic dysfunction (VIDD) which in turn leads to increased morbidity & mortality.
Aim of the Work: To assess of the role of Point of Care Ultrasonography (POCUS) of the lung & diaphragm in extubating mechanically ventilated patients, and the possibility to accredit POCUS of the lung & diaphragm as one of the readiness criteria for extubation.
Patients and Methods: This study is a Prospective Cohort study and included 41 patients who were mechanically ventilated and eligible for extubation and admitted to Critical Care Medicine Department in Ain Shams university Hospitals according to sample size calculation.
Results: There was no statistically significant difference between both groups regarding BMI, sex and Associated morbidities except COPD (P=0.003) while statistically significant difference between both groups was found regarding Agre, history of previous ICU admission (at least 90 days before current admission) and duration of ventilation (days) (p= 0.001, p= 0.02, p<0.001). According to Comparison of hemodynamic data of the studied groups, there was no atistically significant difference between both groups regarding SBP, HR and P/F ratio. According to Comparison of LUS parameters in all studied groups, B lines was significantly higher in Failed extubation group (6.14 ± 2.35) vs (3.48 ± 1.84) in Successful extubation group. Also Lung comets was significantly higher in Failed extubation group (21.47±7.61) vs (8.15±4.39) in Successful extubation group. According to diaphragmatic assessment, mean DE (tidal) was significantly higher in Successful extubation group (15.11 ±0.72 mm) compared to Failed extubation group (8.4 ±0.61 mm) (p <0.001). Also mean of DTE was significantly higher in Successful extubation group (35.12 ±9.65) compared to Failed extubation group (20.06 ±4.72) (p <0.001).
Conclusion: POCUS is safe, sensitive and noninvasive in the assessment of lung and diaphragm and can provide a simple means of assessing diaphragmatic function which can be accredited as one of the readiness criteria for extubation in mechanically ventilated patients and is good predictor of failed extubation from mechanical ventilation.