Ultrasound-guided extubation

Abstract

Introduction: Diaphragm excursion with ultrasound has been possible for more than four decades; recently, importance has been given to ultrasonographic diaphragmatic assessment in the extubation of the ventilated patient.

Objective: To describe the use of diaphragmatic ultrasound for extubation assessment in two patients.

Case presentation: Two cases are presented: the first case is a 79-year-old female patient with a diagnosis of cerebral infarction, coma and bronchopneumonia, who required invasive mechanical ventilation and a spontaneous ventilation test. A diaphragm ultrasound showed a high probability of extubation failure, a reason why the process scheme was modified to correct the causes. The second case is a 68-year-old male patient with a diagnosis of kerosene aspiration pneumonitis who required invasive ventilatory support. When the patient presented improvement in his initial status and oxygenation parameters, diaphragmatic function was assessed by ultrasonography; a high probability of success in extubation was verified, after which the process was achieved without complications.

Conclusions: Diaphragmatic ultrasonography was used; it emerges as a tool of easy access and low cost, for the assessment of the extubation process in ventilated patients. It allowed the exploration of diaphragmatic function directly and at bedside. The assessment of diaphragmatic excursion and diaphragmatic thickening fraction provided a valuable scale for predicting which patients will have a successful extubation or not.