الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Mechanical ventilation (MV) is important in the care of premature infants with respiratory failure. The goal of respiratory support in this population is to maintain adequate gas exchange while minimizing the risk of lung injury. Although MV may be lifesaving, prolonged ventilation is associated with the development of (BPD), pulmonary and systemic infections, damage to the upper airways, and poor neurologic outcome. Early removal of the endotracheal tube (ETT) is thought to be desirable. However, this is often difficult to achieve in preterm infants because of persistent lung disease, inconsistent respiratory drive, and unstable lung volume. We conducted this prospective observational study to Assess diaphragmatic mobility and dimensions for preterm infants ≤ 32 weeks of gestation who were mechanically ventilated and are planned for extubation to non-invasive ventilation to assess the utility of diaphragmatic motility measurements as predictors for extubation success. Our study included 43 mechanically ventilated preterm infants ≤ 32 weeks of gestation. In our study eligible preterm infants were enrolled while receiving MV. The timing of extubation was determined by the clinical team and the decision to extubate was at the discretion of the treating physician. The right and left diaphragmatic movements and dimensions were measured by ultrasonography 1 hour prior to extubation. The patient were classified into successful group (34 patients) or failed group (9 patients) according to the extubation outcome (extubation failure was defined as the need for reintubation within 72 hours after extubation).The sensitivity and specificity of the diaphragmatic dimensions (thickness and excursion) as predictors for successful extubation were calculated using the cut-off values determining by receiver operating characteristic (ROC) curves. The right thickness of diaphragm during expiration (AUC) was 0.53 which was not discriminative. The major findings in our study are that the right and left excursion of the diaphragm. The right excursion of the diaphragm was significantly higher in the successful group than the failed group. Its cut-off point, as a predictor for successful extubation, was 2.65 mm determined from the ROC curve (AUC = 0.98) with a sensitivity of 97.1% and specificity of 77.8%. The left excursion of the diaphragm was significantly higher in the successful group than the failed group. Its cut-off point, as a predictor for successful extubation, was 2.65 mm determined from the ROC curve (AUC = 0.96) with a sensitivity of 94.1% and specificity of 88.9%. They are the most reliable predictors for extubation success as it has the highest AUC.Conclusion : Ultrasonographic evaluation of the right and left diaphragmatic excursion is the most reliable predictor for successful extubation in mechanically ventilated preterm infants with high sensitivity and specificity. Left diaphragmatic thicknesses during inspiration and expiration are highly sensitive predictors for extubation success in mechanically ventilated preterm infants. Ultrasonography is a diagnostic.