COMPARATIVE STUDY BETWEEN THE USE OF ULTRASONIC CRITERIA OF WEANING VERSUS THE CONVENTIONAL CRITERIA OF WEANING IN POST-TRAUMATIC ACUTE RESPIRATORY DISTRESS SYNDROME PATIENTS WHO WERE VENTILATED FOR A LONG TIME
DOI:
https://doi.org/10.51168/sjhrafrica.v5i11.1749Keywords:
ARDS, mechanical ventilation, weaning, ultrasonography, diaphragm excursion, diaphragm thickening, critical care, traumaAbstract
Background
Critically ill trauma patients often need mechanical breathing due to post-traumatic Acute Respiratory Distress Syndrome (ARDS). Weaning from ventilation quickly and precisely prevents ventilator-related issues, shortens ICU stays, and improves outcomes. Traditionally, weaning guidelines rely on clinical assessment and respiratory metrics, which may be insensitive. Recently developed ultrasonography tests, like diaphragmatic excursion and lung ultrasound scores, may better assess weaning readiness objectively and quickly.
Objective: To compare ultrasonic criteria to traditional clinical criteria for weaning post-traumatic ARDS patients who require extended mechanical breathing.
Methods
The study included 87 post-traumatic ARDS patients who needed ventilation for over 72 hours. Patients were randomly assigned to two groups: Group A (Conventional Weaning Criteria): Respiratory rate, tidal volume, minute ventilation, and Rapid Shallow Breathing Index are clinical and laboratory metrics. Group B (Ultrasonic Weaning Criteria): Bedside ultrasound metrics like diaphragmatic excursion (>1 cm), thickening fraction (>30%), and lung ultrasound B-line resolution determine this group. Effective weaning—48 hours of spontaneous breathing without re-intubation—was the main goal. Weaning failure, ICU stay, and post-extubation issues were secondary outcomes.
Results
Group B (ultrasound-guided) had higher weaning success rates (85.7%) than Group A (70.4%). Group B had a shorter average ICU stay (6.2 ± 1.8 days) than Group A (8.4 ± 2.3 days). Ultrasound measurements predicted weaning success with 91% sensitivity and 82% specificity. Ultrasound reduced post-extubation respiratory distress.
Conclusion
Ultrasonographic examination is more accurate and reliable than traditional criteria for assessing weaning readiness in post-traumatic ARDS patients. Its inclusion in critical care protocols may improve weaning and reduce ICU strain.
References
Boles, J. M., Bion, J., Connors, A., Herridge, M., Marsh, B., Melot, C., ... & Welte, T. (2007). Weaning from mechanical ventilation. European Respiratory Journal, 29(5), 1033-1056. https://doi.org/10.1183/09031936.00010206PMid:17470624
DiNino, E., Gartman, E. J., Sethi, J. M., & McCool, F. D. (2014). Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax, 69(5), 423-427. https://doi.org/10.1136/thoraxjnl-2013-204111 https://doi.org/10.1136/thoraxjnl-2013-204111 PMid:24365607
Gottesman, E., & McCool, F. D. (1997). Ultrasound evaluation of the paralyzed diaphragm. American Journal of Respiratory and Critical Care Medicine, 155(5), 1570-1574. https://doi.org/10.1164/ajrccm.155.5.9154862
PMid:9154862
Matamis, D., Soilemezi, E., Tsagourias, M., Akritidou, M., Dimassi, S., Nanas, S., & Roussos, C. (2013). Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications, Intensive Care Medicine, 39(5), 801-810. https://doi.org/10.1007/s00134-013-2823-1 https://doi.org/10.1007/s00134-013-2823-1 PMid:23344830
Palkar, A., & Narasimhan, M. (2016). Bedside ultrasound in the ICU: Part 1. Chest, 149(2), 264-275. https://doi.org/10.1378/chest.15-0467
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Niraj Kumar, Neeraj, Sudama Prasad, Rakesh Kumar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
