Diagnostic Utility of Bedside Lung Ultrasound for Predicting Successful Liberation from Mechanical Ventilation: A Prospective Observational Study
Keywords:
Lung Ultrasound, Mechanical Ventilation, Weaning, Spontaneous Breathing Trial, Extubation Success.Abstract
Background: Accurate prediction of successful liberation from mechanical ventilation remains challenging. Bedside lung ultrasound offers a noninvasive method for assessing pulmonary aeration and potentially improving weaning decisions.
Methods: This prospective observational study included 160 mechanically ventilated adults in a tertiary care intensive care unit. A 12-region lung ultrasound score (LUS) was assessed before the first spontaneous breathing trial (SBT). Successful liberation was defined as extubation within 24 hours following successful SBT, without reintubation or unplanned ventilatory support within 48 hours. Diagnostic performance was compared with the rapid shallow breathing index (RSBI) and PaO₂/FiO₂ ratio.
Results: Successful liberation occurred in 118 patients (73.8%). Median LUS was significantly higher in unsuccessful than successful liberation (19.0 versus 13.0; p < 0.001). LUS demonstrated an AUROC of 0.687, compared with 0.602 for RSBI and 0.524 for PaO₂/FiO₂. At a cutoff of ≥16, sensitivity and specificity were 69.0% and 69.5%, respectively. Each five-point increase in LUS independently reduced the odds of successful liberation (adjusted OR 0.623; p = 0.003).
Conclusion: Pre-SBT lung ultrasound demonstrated moderate predictive accuracy and may complement conventional assessment of readiness for ventilator liberation.
