Objectives: To review the evidence on Diaphragmatic Ultrasonography as a predictor of success in ventilatory weaning. Methodology:Systematically review using the PICO methodology and keywords: Ultrasound, Ultrasound, Diagnostic imaging, Diaphragm, Weaning, Intensive Care Unit, Artificial Respiration, Mechanical Ventilation, Ventilator Weaning. Published cohort studies were used without language and year restrictions that addressed the use of ultrasound to predict success in weaning and ventilatory extubation. Studies with patients under 18 years of age, case reports, literature reviews, results that do not bring a cutoff value for thickness and diaphragmatic excursion and the definition of failure in the weaning and extubation process were excluded. In addition, the Boolean operators “and” and “or” were used. Results:459 were found, which after exclusion due to duplication and reading of titles and abstract, only 11 were selected by the inclusion criteria. The samples ranged from 34 to 193 individuals. We can evidence that the use of USG to assess the thickness and excursion of the diaphragm in patients undergoing invasive ventilatory support is effective in predicting success in the weaning and extubation process. Conclusion: It is concluded that Diaphragmatic Ultrasonography has great applicability to assess the ability to predict success or failure in removing invasive ventilatory support.
Introduction:Cardiac anxiety(CA) is a common finding in patients in the pre- and postoperative period of coronary artery bypass graft(CABG) surgery. Ventilatory restriction generated by pain and reduced muscle strength is associated with increased CA level. Inspiratory muscle training(IMT) for generating increased muscle strength can cause a decrease in CA in the postoperative period. Objective:To evaluate the impact of IMT on inspiratory muscle strength and its relationship with cardiac anxiety in patients undergoing CABG. Methodology:This is a randomized controlled clinical trial. In the preoperative moment, all patients answered a cardiac anxiety questionnaire, composed of two domains: fear and vigilance and avoidance. In addition, their maximum inspiratory pressure(MIP) was assessed. After the surgical procedure, the patients were divided into a control group(CG) that received routine hospital care and a training group(TG) who underwent an IMT protocol until the moment of hospital discharge. Results:80 patients were evaluated,40 in each group. The IMT group showed a 17% decrease in MIP while the CG decreased 43%(p <0.01). The fear and vigilance domain had a decrease of -16±3 in the CG while in the TG the reduction was -8±3(p <0.01). The avoidance domain reduced -17±4 in the CG vs -10±4 in the TG(p <0.01). In addition, there was a strong correlation between the MIP of the TG with the domains of fear/vigilance(r -0.77) and avoidance(r -0.72). Conclusion:IMT is associated with a reduction in the loss of inspiratory muscle strength, resulting in a reduced level of cardiac anxiety in patients undergoing CABG.