Diaphragmatic Ultrasound and Weaning After Lung Transplant.

The prevalence and adverse effect of diaphragm dysfunction (DD) after bilateral-lung transplant (LT) are still unclear, despite a well-known negative impact on weaning and outcome in other cohorts of critically ill and surgical patients.Objects: The primary aim is investigating the prevalence of DD, assessed using point-of-care ultrasound and defined as diaphragm thickening fraction (TFdi) < 29%, at the first weaning trial after LT.Secondary aims are investigating the impact of DD on weaning (defined success or failure according to pre-defined criteria, neuroventilatory efficiency (EAdi or NVE), perioperative (14-day) pneumonia, ICU length of stay (LOS), in-hospital mortality, and identifying potential risk factors for DD. Moreover, we aim to study the correlation between TFdi versus EAdi/NVE and the rapid shallow breathing index (RSBI), respectively.

Inclusion Criteria:Adult patientsbilateral LTabsent invasive mechanical ventilation before surgeryfullfilling 'readiness-to-wean' criteria on daily screening (and therefore deemed ready to undergone a first 30-min weaning trial)Exclusion Criteria:presence of neuromuscular blockers in the previous 12 hourslack of ultrasound acoustic windowdecline to participateright hemi-diaphragmatic palsy due to surgical sacrifice of right phrenic nerveduplicated patients.