Tổng quan vai trò tiên lượng của siêu âm tim, phổi và cơ hoành trong cai thở máy ở bệnh nhân hồi sức

Abstract

Weaning from mechanical ventilation is a critical step in the management of critically ill patients, with extubation failure being associated with increased complications and mortality. Weaning failure is typically the result of multifactorial interactions among hemodynamic disturbances, loss of lung aeration and pulmonary edema, and impaired respiratory muscle function. This narrative review summarizes current evidence on the prognostic role of cardiac, lung, and diaphragmatic ultrasound in predicting weaning outcomes. Cardiac ultrasound helps identify elevated left ventricular filling pressures, lung ultrasound reflects loss of aeration and pulmonary congestion, while diaphragmatic ultrasound assesses respiratory muscle reserve. A multimodal ultrasound approach (cardiac–lung–diaphragm) represents a promising strategy - particularly in high-risk patients such as those with cardiovascular disease, after a major surgery, or prolonged mechanical ventilatio - using a dynamic assessment before and during spontaneous breathing trials and after extubation. However, due to the lack of standardized models and heterogeneity across studies, clinical application requires adequate training, standardized measurement protocols, and integration with overall clinical assessment. Further prospective, multicenter studies are needed to clarify the role of each parameter in specific patient populations.