Anaesthesia and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy.
Department of Translational Medicine, Università del Piemonte Orientale, Novara.
Curr Opin Crit Care. 2022 Jun 1;28(3):322-330. doi: 10.1097/MCC.0000000000000941.
Due to heart, lung and diaphragm interactions during weaning from mechanical ventilation, an ultrasound integrated approach may be useful in the detection of dysfunctions potentially leading to weaning failure. In this review, we will summarize the most recent advances concerning the ultrasound applications relevant to the weaning from mechanical ventilation.
The role of ultrasonographic examination of heart, lung and diaphragm has been deeply investigated over the years. Most recent findings concern the ability of lung ultrasound in detecting weaning induced pulmonary edema during spontaneous breathing trial. Furthermore, in patients at high risk of cardiac impairments, global and anterolateral lung ultrasound scores have been correlated with weaning and extubation failure, whereas echocardiographic indexes were not. For diaphragmatic ultrasound evaluation, new indexes have been proposed for the evaluation of diaphragm performance during weaning, but further studies are needed to validate these results.
The present review summarizes the potential role of ultrasonography in the weaning process. A multimodal integrated approach allows the clinician to comprehend the pathophysiological processes of weaning failure.
由于在机械通气撤机过程中心、肺和膈肌相互作用，超声综合方法可能有助于发现可能导致撤机失败的功能障碍。在这篇综述中，我们将总结与机械通气撤机相关的超声应用的最新进展。
多年来，超声检查对心脏、肺和膈肌的作用进行了深入研究。最近的发现涉及到在自主呼吸试验期间检测撤机引起的肺水肿的肺超声能力。此外，在心脏损伤风险高的患者中，整体和前外侧肺超声评分与撤机和拔管失败相关，而超声心动图指标则不然。对于膈肌超声评估，已经提出了新的指标来评估撤机过程中膈肌的性能，但需要进一步的研究来验证这些结果。
本综述总结了超声在撤机过程中的潜在作用。多模态综合方法使临床医生能够理解撤机失败的病理生理过程。
