RESPIRATORY MUSCLE ULTRASOUND VERSUS RAPID SHALLOW BREATHING INDEX AS A WEANING PREDICTOR IN PROLONGED MECHANICALLY VENTILATED PATIENTS.

Abstract

Mechanical ventilation is a life-saving intervention in intensive care units (ICUs), but prolonged use can lead to complications such as ventilator-induced diaphragmatic dysfunction (VIDD) and increased mortality. Weaning patients from mechanical ventilation is a critical process, with approximately 15% of patients requiring reintubation within 48 hours. Traditional weaning predictors, like the Rapid Shallow Breathing Index (RSBI), have limitations in accuracy. Respiratory muscle ultrasound, particularly diaphragmatic and parasternal intercostal muscle thickening fractions, offers a non-invasive, real-time method to assess respiratory muscle function. This approach has gained attention as a potential tool to improve weaning outcomes and reduce extubation failure rates by providing more precise insights into respiratory muscle performance.AIM :The aim of this study was to propose a systematic ultrasound-based evaluation of the respiratory muscle pump compared with rapid shallow breathing index in ICU patients with prolonged mechanical ventilation.PATIENTS AND METHODSThis prospective observational study included 34 mechanically ventilated patients admitted to the Critical Care Medicine Department at Alexandria University Hospitals. Patients were intubated for over one week and met weaning readiness criteria. Respiratory muscle ultrasound was performed to measure diaphragmatic and parasternal intercostal muscle thickening fractions during spontaneous breathing trials (SBT). The RSBI was also calculated. Patients were categorized into successful (n=19) and failed (n=15) weaning groups based on extubation outcomes 48 hrs. post-extubation. Statistical analysis compared ultrasound parameters and RSBI in predicting weaning success, with a focus on sensitivity, specificity, and predictive accuracy.