Evaluation of Diaphragmatic Dysfunction Associated with Ventilator Weaning Failure in Neonates by Diaphragmatic Ultrasound

Background: Mechanical ventilation is extensively used in neonatal intensive care units. However, many risk factors are associated with mortality rates in neonates on mechanical ventilation. Various techniques have been introduced to assess the weaning time from mechanical ventilation with least risks including diaphragmatic ultrasound. This study aimedat evaluating the role of diaphragmatic ultrasound in predicting failure of weaning from mechanical ventilation in both Full Term (FT) and Preterm (PT) neonates by measuring diaphragmatic excursion before extubation using and determines a cut off value for diaphragmatic excursion for expecting weaning failure.
Patients and Methods: A prospective cohort study was performed in the neonatal intensive care unit (NICU) of Mataria Teaching Hospital (MTH) from June 2018 to May 2019. All full and pre-term neonates who need mechanical ventilation from first day of admission were included major congenital anomalies, need surgical intervention, congenital diaphragmatic hernia, weaned before 72 hours, pleural effusion, hepato-splenomegaly were excluded.
Results: Neonates with low gestational age, presence of respiratory distress, longer period on mechanical ventilation and higher ventilator setting were more prone to weaning failure. Additionally, excellent sensitivity and specificity of diaphragmatic ultrasound in prediction of weaning failure in neonates especially in full term whether using excursion of right and left hemidiaphragm. Conclusion: Bedside ultrasound can predict weaning failure through measuring right or left diaphragmatic excursion in full term and preterm neonates.