Ultrasonography: Friendly tool for weaning from ventilatory support

Abstract

Failure to wean off from artificial ventilatory support is associated with an increased patient morbidity and mortality, with a big psychological impact on the relatives. It is defined as the incapacity to maintain or generate spontaneous breathing for at least two days, without any form of ventilatory support following the removal of an airway device such as an endotracheal tube.¹ Ventilator-induced diaphragmatic dysfunction, co-existing thoracic and abdominal pathology, muscular dystrophy or respiratory muscle myopathy in the setting of nutritional deprivation or secondary to prolonged use of steroids and neuromuscular blockers, or co-existing cardiac disease are the most common inciting factors.^2-4 Spontaneous breathing trials to wean off from mechanical ventilation may fail in approximately one fifth of the admitted patients. A valuable use of ultrasonography in the critical care setting is the assessment of the mechanical working of the diaphragm in such patients. The diaphragm plays a major role in enabling the individual patients to resume breathing spontaneously.