الفهرس 
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Abstract
Summary and conclusions
inimizing the duration of mechanical ventilation (MV) is of a paramount importance for all critical care physicians. Therefore, deciding the appropriate time of weaning from MV is crucial, as delayed weaning and extubation is associated with longer intensive care unit (ICU) stay, inappropriate utilization of health care resources, and greater morbidity and mortality.
Although rates of weaning and extubation failure differ considerably among ICUs, approximately 15% of patients in whom mechanical ventilation is discontinued require reintubation within 48 hours. Consequently, it is fundamental for critical care physicians to differentiate between readiness for discontinuation of ventilation and successful spontaneous breathing trials.
The rapid shallow breathing index (RSBI), calculated from respiratory rate divided by tidal volume (RR/TV), is a well-known weaning index and one of the most clinical indices used to predict weaning outcome. However, it has some limitations in predicting weaning outcomes.
The imbalance between the mechanical load imposed on the diaphragm; which is the major muscle of inspiration; and its ability to cope with it, necessitates evaluating the
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Summary and Conclusion
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function of diaphragm before any weaning trial, which could be useful in predicting weaning outcome.
Diaphragmatic displacement (DD); reflecting the ability of diaphragm to produce force and subsequently tidal volume during inspiration and defined as displacement of less than 10mm; has been found to be a predictor of weaning failure among patients in medical ICUs.
This work aimed at comparing the ability of the new index diaphragmatic rapid shallow breathing index (D-RSBI) and the traditional rapid shallow breathing index (RSBI) to predict weaning outcome.
This was a prospective observational study, conducted at the ICU of Abbassia Chest Hospital, in the period from October 2017 to September 2018. The study included 50 patients and they were be enrolled in the study after their informed written consent (by them or by their relatives), and approval of Ethics committee of Hospital was obtained.
In this study, regarding demographic data of the patients, there was statistically significant difference according to age. This difference could be attributed to the larger number of successfully weaned patients (33 patients), regarding sex and smoking there was no statistically significant difference between successful and failed weaning.
Summary and Conclusion
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There was statistically significant prevalence of HTN among successfully weaned patients, while there was no statistically significant difference between successfully weaned and patients failed to be weaned as regards other chronic diseases (DM, CLD).
There was highly statistically significant prolonged ICU length of stay and prolonged maintenance on MV among the patients who failed to be weaned.
Regarding the indices in our study; there was no significance in prediction of success or failure of weaning by using RSBI, while there was a very high level of significance in prediction of successful or failure of weaning by using both D-RSBI and DD.
Regarding logistic regression analysis of association between (RSBI, DD and D-RSBI) and outcome of ventilation; RSBI value > 47.7 discriminated individuals with failure of weaning from those with successful weaning, while DD value < 19.85 discriminated individuals with failure of weaning from those with successful weaning and D-RSBI value > 1.09 discriminated individuals with failure of weaning from those with successful weaning.
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Conclusions
Diaphragmatic ultrasonography provides rapid, bedside and non-invasive tool for prediction of weaning outcome. Diaphragmatic displacement (DD), when combined with respiratory rate (RR) in an index that we named diaphragmatic rabid shallow breathing index D-RSBI (RR/DD), is more accurate than the traditional RSBI (RR/TV) in predicting the weaning outcome. Regarding D-RSBI, a cut-off point of 1.09 is associated with the best sensitivity and specificity.