Diaphragmatic dysfunction evaluation using ultrasonography as a predictor of weaning for patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease from mechanical ventilation
Journal Title: Journal of Medical Science And clinical Research - Year 2016, Vol 4, Issue 6
Abstract
Introduction: Diaphragmatic Excursion (DE) was used as a predictor for weaning of mechanical ventilation (MV) but not for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Objectives: To correlate between Diaphragmatic dysfunction (DD) and outcome of mechanically ventilated AECOPD patients. Materials and Methods: 60 wean able mechanically ventilated patients with AECOPD were prospectively enrolled. M-mode U/S evaluation of the diaphragm was done using convex probe 3.5-5 MHZ in the supine position at the start of spontaneous breath trial on T-piece. Patients were randomized into two groups; DD (< 1 cm excursion) and non-DD (> 1 cm excursion). Outcomes of the ICU stay were determined. Results: Ten patients with DD had primary weaning failure versus two in the non-DD group, while six patients with DD had secondary weaning failure. There was significant reduction in duration of weaning, ICU and hospital length of stay in favor of non-DD group (2.5, 5 and 6 days, respectively; (p < 0.001)). For predicting weaning failure, the test showed 88.89% sensitivity, 97.62% specificity, 94.12% positive predictive value and 95.35% negative predictive value. Conclusions: DD detected by M-mode U/S was associated with prolonged duration of mechanical ventilation, ICU, hospital stay, and weaning failure in AECOPD patients.
Authors and Affiliations
Emadeldin Mahmoud Zakaria
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