Giá trị tiên lượng của chỉ số siêu âm phổi và cơ hoành trong cai thở máy ở bệnh nhân hồi sức ngoại khoa

Mechanical ventilation is a cornerstone of critical care, particularly for postoperative patients in the intensive care unit. However, prolonged ventilation is associated with severe complications, including ventilator-associated pneumonia, respiratory muscle dysfunction, and increased mortality. Therefore, timely and accurate prediction of mechanical ventilation weaning success is crucial to minimize patient morbidity and mortality and optimize resource utilization. Weaning failure, occurring in a significant percentage of patients, necessitates reintubation and prolonged mechanical support, underscoring the need for reliable predictive tools. In this context, non-invasive, bedside diagnostic methods like lung ultrasound and diaphragm ultrasound have emerged as promising approaches to assess respiratory muscle function and lung aeration, offering valuable insights into a patient's readiness for extubation.

Critical care physicians, intensivists, anesthesiologists, respiratory therapists, and researchers involved in mechanical ventilation management and weaning.

This study aimed to evaluate the predictive utility of the lung ultrasound score (LUS), diaphragmatic excursion (DE), and diaphragm thickening fraction (DTF) for weaning outcomes in surgical intensive care unit patients. Researchers conducted a prospective observational study involving 74 postoperative adults who had received invasive mechanical ventilation for at least 48 hours and met readiness criteria for weaning. Patients underwent a spontaneous breathing trial, with lung and diaphragm ultrasonography performed at the beginning and end. The findings revealed that 54 out of 74 patients (72.97%) were successfully weaned. The lung ultrasound score demonstrated superior predictive performance with the highest area under the receiver operating characteristic curve (AUC) of 0.94, achieving 96% sensitivity and 80% specificity at a cut-off of 10 points. Similarly, diaphragm thickening fraction showed strong predictive value with an AUC of 0.91, providing 87% sensitivity and 90% specificity at a cut-off of 22.5%. In contrast, diaphragmatic excursion exhibited a lower AUC of 0.71, with 91% sensitivity but only 47% specificity. These results conclusively indicate that ultrasound-derived indices are valuable predictors for extubation prediction in this patient cohort. Specifically, both lung ultrasound score and diaphragm thickening fraction offer significantly better discriminative performance compared to diaphragmatic excursion for anticipating weaning success. The application of these non-invasive, bedside ultrasound techniques holds significant clinical implications, enabling intensivists to more accurately assess a patient's readiness for mechanical ventilation weaning, potentially reducing complications and improving patient outcomes in postoperative intensive care settings.