Critical Care Ultrasound Guided Weaning

Study Overview
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Brief Summary
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Weaning patients from the ventilator in the intensive care unit is sometimes difficult because of three main interrelated etiologies: impaired lung, heart or diaphragm function. In this context, ultrasonography performed during tests for extubation of patients may enable the diagnosis of cardiac dysfunction, loss of pulmonary aeration, diaphragm dysfunction, and venous congestion, thereby reducing the number of failures in extubation. The combination of TTE (Trans Thoracic Echocardiography), LUS (Lung Ultrasound), DUS (Diaphragmatic ultrasound) and VEXUS (Venous excess Ultrasound) may enable the identification of the etiology of weaning failure and reduce the number of extubation failures by enabling the development of an appropriate treatment strategy. With this study, it is aimed to contribute to the literature in this sense.

Detailed Description
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The aim of this study is to reduce the number of extubation failures by defining the etiology of weaning failure and developing appropriate treatment strategies by using intensive care ultrasonography applications in combination (defining cardiac, pulmonary, diaphragmatic and venous congestion). Most patients can be extubated after the first SBT (spontaneous Breathing Trial). A patient who fails extubation is automatically classified as difficult weaning, and intensive care professionals frequently encounter patients who are difficult to wean from mechanical ventilation. Before performing a new SBT following a failed SBT, the cause of the failure should be determined and an appropriate treatment strategy developed.

Official Title
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Critical Care Ultrasound Guided Weaning

Conditions
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Weaning Failure

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Invasive mechanical ventilation > 24 hours Eligibility to weaning from mechanical ventilation Exclusion Criteria: Age < 18 years old Severe skin lesions or infections that cannot perform ultrasound Severe subcutaneous emphysema that cannot perform ultrasound Patients with a known neuromuscular disease Patients with a duration of mechanical ventilation <24 hours, Patients with severe mitral stenosis, severe mitral regurgitation, or prosthetic mitral valve

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| weaning failure<br>Unstable patient without mechanical ventilator support within 48 hours | |
| weaning success<br>Stable patient for more than 48 hours without mechanical ventilator support | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mechanical ventilation weaning success | Weaning success: stable without mechanical ventilator support during more than 48 hours | 48 hours | 
| Mechanical ventilation weaning failure | Weaning failure: unstable without mechanical ventilator support within 48 hours | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality | Incidence of ICU mortality | ICU mortality after ultrasonography guided weaning |