Acil Serviste Entübe Hastalarda Ekstübasyon Öncesinde Diyafram Kalınlığı ve Hareketlerinin Sonografik Olarak Değerlendirilmesinin Ekstübasyon Başarısına Etkisi

Abstract

Acute respiratory failure is one of the most common conditions in the emergency room. The intubation rates in these patients reach 60%. Approximately 40% of patients in intensive care units are followed up with mechanical ventilators, and difficulties are encountered in the weaning phase in 20-25% of these patients. The aim of this study is to investigate the relationship between the evaluation of diaphragm thickness and movements by ultrasonography and the success of extubation in patients scheduled for extubation in the emergency department. Bedside sonographic evaluation was performed 0-6 hours before extubation. Diaphragm thickness, diaphragm thickness at the end of inspiration and expiration, diaphragm excursion (Diaphragm Excursion-DE), diaphragm thickening fraction (Diaphragm Thickening Fraction-DTF) and diaphragm thickening index (DTI) were evaluated. 23 patients were included in the study. Extubation process was successful in 18 (78,3%) of 23 patients included in the study, while it was unsuccessful in 5 (21,7%). The diaphragm was measured thicker (3,5 mm versus 3,3 mm) in patients who failed in extubation process. DISK, DE, DTF and DTI values were higher in patients with successful extubation process (DISK: 4,12 mm by 3,45 mm; DE: 1,41 cm by 0,61 cm; DTF: 43% to 12% DTI: 35% to 10%), and DESK value was higher in patients who failed in extubation process (3,08 mm vs 2,76 mm), but these differences were not statistically significant. It was concluded that prospective studies with larger number of patients are needed to demonstrate the effect of diaphragm thickness, DISK, DESK, and DE and DTF values measured by USG in predicting succesfull extubation success.