Assessment of readiness to wean an elderly patient from mechanical ventilation using clinical and diaphragmatic ultrasound predictors: a case report
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Abstract
Background: Weaning from mechanical ventilation is a critical and high-risk phase of intensive care management, particularly in elderly patients. One-fifth of mechanically ventilated patients experience difficulty during weaning and conventional clinical assessment may be unreliable, necessitating the use of objective physiological indices. Weaning predictors such as the rapid shallow breathing index and diaphragmatic ultrasonography have been shown to support decision-making when clinical evaluation is limited.
Aim: Report the use of combined clinical criteria and diaphragmatic ultrasound parameters in assessing readiness for weaning from mechanical ventilation in an elderly patient with cognitive impairment.
Case Report: A 70-year-old female with multiple ischaemic cerebrovascular accidents and vascular dementia was admitted following head trauma complicated by bilateral subdural haematomas. She underwent burr-hole evacuation and required postoperative mechanical ventilation with sedation. After 26 hours of ventilatory support, standard clinical criteria for weaning were fulfilled. Spontaneous breathing test was performed using low-level pressure support ventilation. Objective weaning predictors were assessed, including the rapid shallow breathing index and diaphragmatic ultrasound parameters. Rapid shallow breathing index was 38 breaths/min/L. Diaphragmatic ultrasonography demonstrated a diaphragm thickening fraction of 41.25% and a diaphragm excursion of 162 mm. Spontaneous breathing test was completed successfully without respiratory distress or haemodynamic instability.
Conclusion: This case highlights the clinical value of integrating conventional weaning criteria with diaphragmatic ultrasound assessment in elderly patients with neurological and cognitive impairment. Objective evaluation of diaphragmatic function enhances confidence in extubation decisions and may reduce the risk of weaning failure in complex clinical settings.
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