Abstract Background Diaphragm dysfunction is a major contributor to delayed liberation from mechanical ventilation and extubation failure. Point-of-care ultrasound (POCUS) enables bedside quantification of diaphragm thickening fraction (TFdi), a dynamic index of contractility, but its incorporation into routine weaning assessments remains limited. We aimed to evaluate whether integrating diaphragm ultrasound into daily weaning readiness evaluations improves extubation outcomes and reduces ventilation duration among medical ICU patients. Methods We conducted a prospective, randomized interventional study involving 120 mechanically ventilated adults in a tertiary medical ICU between January and August 2024. Patients were randomized 1:1 to either a conventional weaning group, where readiness was based on standard clinical and respiratory parameters, or an ultrasound-guided group, where diaphragm TFdi was measured daily using a 7-10 MHz linear probe at the zone of apposition. A TFdi ≥20% was used as an additional readiness criterion to initiate spontaneous breathing trials (SBTs). Both groups received standard ICU care, sedation protocols, and physiotherapy. Primary outcomes included total ventilation duration and extubation failure (defined as re-intubation within 48 hours). Secondary outcomes were ICU length of stay and adverse events related to ultrasound use. Statistical analyses used the Mann-Whitney U test and chi-square test, with significance set at p 0.05. Results A total of 117 patients completed the study (59 in the ultrasound-guided group and 58 in the control group). Baseline demographics, illness severity, and ventilator settings were comparable between groups. Median duration of mechanical ventilation was 4.5 days (IQR 3.8-5.9) in the ultrasound-guided group versus 6.1 days (IQR 4.9-7.2) in controls (p = 0.01). Extubation failure occurred in 9% of ultrasound patients compared with 20% in the control group (p = 0.04). ICU length of stay was reduced by 1.2 days (6.7 vs 7.9 days, p = 0.03). No complications related to diaphragm imaging were observed. Conclusion Incorporating daily diaphragm ultrasound into standard weaning assessments significantly shortened ventilation duration and reduced extubation failure without added risk. Routine TFdi monitoring provides a non-invasive, physiologic marker to guide individualized weaning decisions, supporting its adoption as a feasible bedside tool in ICU liberation protocols. This abstract is funded by: none
Pugazhendi et al. (2026) studied this question.