Ultrasonography of respiratory muscles to estimate the probability of extubation failure after cardiothoracic surgery

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The failure of weaning from mechanical ventilation can be associated with a diaphragmatic dysfunction after thoracic cardiovascular surgery. Ultrasound measurements of diaphragm tickening may be useful to monitor diaphragm activity of each half diaphragm. We expect to establish a sonographic criteria during the spontaneous breathing trial (SBT) to predict weaning failure from mechanical ventilation after cardio thoracic surgery. Patients after majors cardio or thoracic surgery who met criteria for a spontaneous breathing trial will be enrolled. All patients with a half diaphragm paralyzed will be excluded. Diaphragm thickness (tdi) will be measured in the zone of apposition of the diaphragm to the rib cage using a 10-MHz linear ultrasound probe. Diaphragm thickening fraction (TFdi) will be defined as the percentage change in tdi between end-expiration and end-inspiration. Those index will be calculated in each patients during ventilation with pressure support (PS) and during SBT on the right and left sides. Weaning failures will be defined by reintubation within 48 hours post extubation or failure of the SBT. We have planne to enrolled prospectively 48 patients. We will evaluate the sensitivity and specificity of diaphragm thickening fraction to predict SBT or extubation failure. The area under the receiver operating characteristic curve will be calculated. We expected to show that ultrasound measures of diaphragm thickening may be useful to predict extubation success or failure.

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