Lung ultrasound: a useful tool in the weaning process? - Critical Care Science (CCS)

INTRODUCTION

The incidence of pulmonary complications related to mechanical ventilation is an important issue among critically ill patients. Reducing the duration of respiratory support is essential for minimizing these complications. The extubation of a patient marks the end of the weaning process. Unfortunately, even after a successful spontaneous breathing trial (SBT), approximately 30% of patients develop respiratory distress within 48 hours of extubation; this results in extubation failure and requires either therapeutic non-invasive ventilation or reintubation.⁽⁾ The loss of pulmonary aeration following extubation is a hallmark of extubation failure, leading to impaired gas exchange, prolonged mechanical ventilation, and increased morbidity and mortality.⁽⁾ The pathophysiology is multifactorial.

The amount of lung aeration loss can be quantified via lung ultrasound during different clinical conditions including the weaning process. It is a non-invasive and radiation-free procedure, which can be performed quickly at the bedside and enables a dynamic assessment of lung aeration changes depending on ventilation conditions, as opposed to a chest x-ray. For many years, lungs were not considered accessible by ultrasound because air does not allow for the transmission of ultrasound waves. However, the artifacts produced at the interface between the lungs and fluids, for example, can be easily identified by lung ultrasound.

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