ICU Patients: A Case Study
Introduction
Liberation from mechanical ventilation in Intensive Care Unit (ICU) patients is a perfect blend of art & science in medicine. The science remains in searching for the major indicators of restoration of physiology whereas the astute judgment of the clinician still plays a crucial role in picking up all those who can breathe without support. There has been a significant volume of work on weaning from early nineties but most of them have failed to show universal reliability and reasonable predictive values. We shall make an effort to summarize the important research work done in this domain and what has it lead us to.
What do we mean by weaning?
Weaning from ventilator has two separate aspects: one is liberation from ventilator and the other is removal of the artificial airway.
How to identify that the patient is ready to
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21hrs favoring normal renal function.) [21]
What is the role of Ultrasonography in weaning?
Apart from echocardiography, ultrasonography (US) of the lungs and airways has emerged as a rapid bedside procedure in predicting weaning failure.
• B-mode lung US gives early indication of heart failure by increased number of B-lines, which corresponds with wet lungs.
• Using M-mode ultrasonography, diaphragmatic dysfunction (vertical excursion of < 10mm and paradoxical movement) was found in 29% of medical intensive care unit patients without histories of diaphragmatic disease. Patients with such diaphragmatic dysfunction showed frequent early and delayed weaning failures.
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