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Initiation of weaning from mechanical ventilation by progressive withdrawal from invasive ventilator support until removal of the endotracheal tube might represent approximately 42% of the duration of mechanical ventilation.
SBT assesses the ability of the patient to breathe while receiving minimal or no ventilator support. Adequate performance of SBT does not necessarily result in successful extubation. The process of SBT start by assessing the underlying cause of respiratory failure has be removed or not.
Multiple parameters subjective & objective had been successfully used to determine reversal of the disease and readiness for weaning. Bedside assessments tools are also crucial during weaning. Ultrasonography (USG) has been used in the routine assessments of seriously ill patients for diagnostic approach and follow-up. It is a convenient tool to evaluate cardiac function, diaphragm function, lung aeration.
The present study is a prospective randomized cohort study conducted on 50 children who had been admitted to Pediatric Intensive Care Units (PICUs), Pediatric Hospital, Ain Shams University, in the period between March 2018 to March 2019. The aim of the study was to assess the ability to use lung, diaphragmatic ultrasound and transthoracic echocardiography (TTE) to identify different indices that could help in predicting the weaning outcome in ventilated pediatric patients. Also it studied the value of Rapid Shallow Breathing Index (RSBI) and Integrated Weaning Index (IWI) measured at initiation and termination of a SBT in predicting the weaning outcome.
The demographic data of the study showed that the patients were 27 males and 23 females with age ranged from 1 to 180 months, range of weight was 2 to 40 kg, mean HR was 121.56 ± 22.77 b/m, mean RR was 33.92 ± 9.09 breath/m, mean temperature was 36.9 ± 0.43ºc, mean Systolic blood pressure was 99.24 ± 13.31 mmHg, mean Diastolic Bl.pr was 65.6 ± 11.95 mmHg, and mean UOP was 3.04 ± 1.08 cc/kg/hr, the mean of initial ABGs were (pH 7.4 ± 0.05, PaCo2 38.56 ± 3.56, PaO2 147.44 ± 38.46) and the mean of P/F ratio was 390.26 ± 117.9, 22% were intubated due to pneumonia, 20% due to septic shock and 12% due to pneumonia with other co-morbidities.
Patients were divided into two groups according to the outcome into success group of extubation (n= 38) and failure group (n= 12) there was statistical difference between both regarding DBR, HR and RR, also PaO2 and P/F ratio showed statistically significant difference between both groups, also significant difference as regard length of stay in PICU between both groups
Fifteen patients were ready for extubation with (mean PIP, PEEP, Rate, Fio2, MAP, VT, RSBI, IWI= 14.54 ± 0.71, 4.78 ± 0.42, 32.34 ± 7.59, 0.47 ± 0.08, 7.88 ± 0.95, 6.98 ± 0.84, 3.74 ± 2.35, 17.65 ± 4.51) with statistically significant difference between different mechanical ventilation measures at imitation and at the termination of SBT.
The mean RSBI was 3.86 ± 2.34 (Breath/min/ml/kg) which was statistically significant between success and failure group and the results of AUC of RSBI at cut off point (>3.7) showed statistical significant with outcomes with 66.67 sensitivity and 60.53 specificity.
The mean IWI was 19.45 ± 6.16 which was statistically significant between success and failure group and the results of AUC of IWI at cut off point (≤13.6) showed statistical significant with outcomes with 91.67 sensitivity and 100 specificity.
The mean lung ultrasound score was 7.28 ± 4.72 which was statistically significant between success and failure group and the results of AUC of lung ultrasound score at cut off point (>10) showed statistical significant with outcomes with 66.67 sensitivity and 94.74 specificity.
The mean of DTF (RT side) was 13.39 ± 5.81 (%), the mean of DTF (LT side) was 13.54 ± 4.74 (%) both were highly statistically significant, while the mean of diaphragmatic excursion (RT) was 0.61 ± 0.13 (mm), the mean of diaphragmatic excursion (LT) was 0.72 ± 0.13 (mm) both were statistical insignificant.
The mean of LV EF was 68.08 ± 7.25 (%), the mean of E/A ratio was 2.74 ± 1.17, also the mean of 3.06 ± 1.48, all were statistically significant between both groups.