Predictive Value of Ultrasonic Diaphragm Thickening Fraction on Successful Weaning in Postoperative Cardiothoracic Surgery Patients with Chronic Obstructive Pulmonary Disease (COPD)

Abstract Background The diaphragm is the most important muscle of respiration and is largely responsible for the change in the intra thoracic pressure. In mechanically ventilated patients, the diaphragm can develop atrophy and weakness leading to prolonged duration of mechanical ventilation. Many studies reported a high prevalence of diaphragm dysfunction during weaning, and it was found to be associated with poorer clinical outcomes. Objective To assess the predictive value of diaphragm thickening fraction (DTF) by bedside ultrasound on successful weaning in postoperative cardiothoracic surgery patients with COPD. Subjects and Methods This prospective study was conducted on 40 subjects at cardiothoracic ICU unit at Elmaadi Military hospital during the period from (September,2021) to (July,2022) after approval of the research Ethical committee at faculty of medicine, Ain shams university. Results Regarding the relation between the two studied groups and diaphragmatic thickness, the thickness was decreased in the failed group than the successful group during inspiration, expiration and thickness fraction %, with significant difference between two groups as p-Value was <0.05. There was an increase in the duration of ICU stay & mechanical ventilation in the failed group compared to the successful group, with significant difference between two groups as p-Value was <0.05. Regarding the correlation between ICU stay & mechanical ventilation and diaphragmatic thickness, there were negative correlation between ICU stay & MV duration and all parameters of the diaphragmatic thickness, with significant difference as p-Value was <0.05. Conclusion Weaning success in mechanically ventilated postoperative cardiothoracic surgery patients with COPD can be predicted by ultrasonography-based evaluation of diaphragm function by analyzing diaphragmatic thickness fraction. It is a practical, feasible, non-invasive technique that may be used at the bedside to rule out diaphragmatic dysfunction.