Extubation Guided by Bedside Ultrasound

Plain-language summary

The aging of the global population has led to an increased number of surgical procedures being performed on elderly patients. However, with aging, the main structure and function of the lungs undergo progressive changes involving lung elasticity , impaired defense mechanisms, weakened respiratory muscle strength, and lessened responsiveness of the lungs to anesthesia . Smetana showed that nearly 33% of patients older than 65 years of age who undergo surgical procedures develop postoperative pulmonary complications. It can be seen that elderly patients are themselves at high risk of pulmonary complications .Common postoperative pulmonary complications include pleural effusion, atelectasis, pneumonia, acute respiratory distress syndrome, cardiogenic pulmonary edema, and postoperative need for mechanical ventilation.This can lead to prolonged hospitalization, increased economic burden on patients, and increased long-term mortality . Therefore, accurately determining factors influencing successful postoperative weaning and extubation in elderly patients is crucial to reduce complications. Clinical practice guidelines for critically ill patients in general recommend a well-defined, albeit imperfect, protocolized weaning and extubation procedure, including the evaluation of weaning readiness, spontaneous breathing trial (SBT) assessment, extubation, and consideration of prophylactic noninvasive ventilation or high-flow nasal oxygen.However, even if the SBT is successful, 3%-30% of patients still need to be reintubated due to respiratory distress after removal of the endotracheal tube . Predicting successful extubation in these patients is difficult. Predicting successful extubation remains difficult even after a successful SBT. The decision often relies on SBT results and clinical judgment, which can be unreliable. Identifying objective factors associated with extubation failure is therefore essential. Lung ultrasound score (LUS)has been shown to accurately predict extubation failure by detecting significant pulmonary edema during SBT,and diaphragm excursion (DE)can be used to quantitatively assess diaphragm activity to assess extubation success. However, these studies primarily involved ICU patients with mixed medical and surgical conditions. Data specifically focusing on elderly surgical patients in the Post-Anesthesia Care Unit (PACU) are limited.Given this background, we conducted this multicenter prospective observational study to investigate the association between lung ultrasound parameters (LUS, DE), oxygenation index (OI), and other clinical and laboratory factors with extubation failure specifically in elderly surgical patients recovering in the PACU.

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