Identification of effective weaning through diaphragmatic ultrasound added to clinical parameters among mechanically ventilated patients in the intensive care unit at a tertiary care center: A prospective observational study.

Abstract

Background: Effective and timely weaning is essential for improving the outcome of intensive care unit (ICU) patients. This study was conducted to determine whether diaphragmatic thickness fraction measured by ultrasound provides any additional benefit when combined with clinical parameters for successful weaning.

Methods: This prospective observational study was conducted on 100 mechanically ventilated patients in the ICU. When the criteria for weaning were satisfactorily fulfilled, a spontaneous breathing trial was administered. Rapid Shallow Breathing Index (RSBI) and bedside ultrasound to measure diaphragmatic thickness fraction (DTF) were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RSBI and DTF were calculated utilizing a cutoff value of RSBI <82 and a DTF cutoff of >37%. The predictability of weaning success was evaluated by the area under the receiver operating characteristic curve (AUROC).

Results: Of the 100 patients observed, 68 patients had weaning success while 32 patients experienced weaning failure. The sensitivity, specificity, PPV, and NPV of RSBI were greater compared to DTF (88.23%, 96.87%, 98.36%, and 79.48% vs. 88.23%, 84.37%, 92.30%, and 77.14% respectively). The AUROC values for RSBI, DTF, and their combination were 0.86, 0.78, and 0.90, respectively. The Pearson correlation coefficient of RSBI with DTF was found to be -0.475.

Conclusion: RSBI proved to be a highly reliable predictor of successful weaning, demonstrating superior diagnostic accuracy. The combination of RSBI and DTF improved the diagnostic validity profile, suggesting that integration of diaphragmatic ultrasound with conventional clinical indices enhances the reliability of weaning assessment.