The goal of this observational study is to evaluate the predictive value of diaphragmatic ultrasound compared to the Rapid Shallow Breathing Index (RSBI) in determining weaning success among mechanically ventilated patients in the ICU for more than 48 hours.
The main question it aims to answer is:
Which is more effective in predicting weaning success: diaphragmatic ultrasound (including Diaphragmatic Excursion \[DE\] and Diaphragm Thickening Fraction \[DTF\]) or RSBI, in patients ventilated \>48 hours in the ICU of Dr. Sardjito General Hospital, Yogyakarta?
Participants will be adult ICU patients who are undergoing weaning from mechanical ventilation after more than 48 hours. Before extubation, each participant will undergo diaphragmatic ultrasound assessment to measure DE and DTF, along with RSBI measurement. The predictive accuracy of these parameters will be evaluated by comparing them with the actual weaning outcomes.
Secondary objectives include:
1. Assessing whether diaphragmatic ultrasound is associated with a higher weaning success rate than RSBI. 2. Evaluating the correlation between DE values and successful weaning. 3. Determining the optimal cutoff values of DE and DTF as predictors of weaning failure. 4. Analyzing the incidence of weaning failure in patients who do not meet optimal diaphragm function criteria. 5. Identifying DE and DTF thresholds that may help reduce the risk of reintubation.
Patients who have been on mechanical ventilation for more than 48 hours
Adult patients aged ≥18 years
Patients who meet the criteria for hemodynamic stability for weaning
Patients or their families have provided written informed consent
Patients with neuromuscular disorders, anatomical abnormalities of the diaphragm, or diaphragmatic palsy
Patients with a history of severe thoracic trauma affecting diaphragm function on one or both sides
Pregnancy
The study population consists of subjects who meet the predetermined criteria. The target population refers to the broader group to which the results of this study are intended to be applied. This population is general in nature but limited by clinical and demographic characteristics. The accessible population is a subset of the target population, defined by place and time, which can be reached by the researcher and will ultimately serve as the source of study participants (Sastroasmoro and Ismail, 2008).The target population in this study comprises adult male and female patients who are on mechanical ventilation in the Intensive Care Unit (ICU) at Dr. Sardjito Hospital, Yogyakarta. The accessible population includes patients with indications for weaning from mechanical ventilation in the ICU of Dr. Sardjito Hospital during the study period.
Cohort
Prospective
Not listed
Extubation Success Rate
Proportion of patients who remain extubated for at least 48 hours following planned extubation.
Diagnostic Accuracy of RSBI, Diaphragmatic Excursion, and Diaphragmatic Thickening Fraction (DTF) for Predicting Extubation Success
Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) will be calculated for diaphragmatic excursion and diaphragmatic thickening fraction (ΔTdi%) to predict successful weaning from mechanical ventilation. Receiver Operating Characteristic (ROC) curve analysis will be used to evaluate and compare the clinical utility of RSBI, diaphragmatic excursion, and DTF in predicting extubation success.
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