Point-of-care ultrasonography and liberation from mechanical ventilation

Excerpt

Safe liberation from mechanical ventilation remains a challenge for the critical care physician. Undue prolongation of mechanical ventilation or extubation failure followed by re-intubation is associated with negative outcome. Recent clinical practice guidelines suggest using pressure augmentation during a spontaneous breathing trial (SBT), which would result in more successful SBTs and higher extubation rates. However, despite pressure augmentation, the extubation success rate was only 75.4% [1], reflecting the significant limitation of the SBT to predict extubation success. Moreover, other predictors of weaning success like the Rapid Shallow Breathing Index (RSBI), respiratory system compliance and MIP lack significant predictive value. The guidelines also suggest extubation to preventive non-invasive ventilation (NIV) for patients at high risk for extubation failure despite a successful SBT, which again reflects the limitations of the SBT. High-risk patients were defined variably in different studies, further complicating the task of identifying the vulnerable group of patients who would potentially fail extubation [1]. …