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Background Early release of patients from mechanical ventilation and intubation associated with significant decrease in mortality and morbidities. Aim Evaluation of echocardiography and oxidative stress markers in the prediction of weaning failure. Patients and methods In all, 120 mechanically ventilated patients were included in the study. Patients were evaluated by tissue Doppler transthoracic echocardiography before and during the spontaneous breathing trial (SBT). In addition to ventilatory parameters, blood samples were obtained for the measurement of lipid peroxidase, glutathione oxidase, and nitric oxide. Different parameters were compared between failed and successful weaning groups. Results During SBT, respiratory rate, heart rate, and rapid shallow breathing index (RSBI) were significantly increased compared with before SBT. The serum level of nitric oxide before SBT was significantly decreased in the failed group. All cardiac dimensions significantly increased during SBT compared with before SBT; moreover, the left ventricular dimensions increased significantly in the failed group during SBT. There was significant decrease in right ventricular systolic function during SBT as estimated by tricuspid annular plane systolic excursion (TAPSE) and myocardial performance index. Weaning success was positively correlated with tidal volume, TAPSE, and nitric oxide, while negatively correlated with lipid peroxidase, respiratory rate, left ventricular end-diastolic dimension, and E/E' of lateral mitral valve annulus. Tidal volume more than or equal to 493 ml before SBT had the highest sensitivity for predicting successful weaning; on the other hand, during SBT left ventricular end-diastolic dimension less than or equal to 5.05 cm had 100% sensitivity and TAPSE more than or equal to 1.65 had 88.9% sensitivity. Respiratory rate less than or equal to 27.5 during SBT had the highest specificity (72.7%). Conclusion In comparison to oxidative stress markers, clinical assessment and bedside transthoracic echocardiography have higher sensitivity, so they can be considered valuable and cheap predictors of successful weaning. [ABSTRACT FROM AUTHOR]

Background Adult respiratory distress syndrome (ARDS) and acute cardiogenic pulmonary edema (CPE) are common clinical issues. Based on clinical data, it is a big challenge to differentiate between both. Secondary to many limitations of computed tomography, chest ultrasound (CUS) provides pleuropulmonary signs that help in differentiation. Objective The current work aimed to assess the accuracy of CUS in differentiating CPE from ARDS. Patients and methods This is a cross-sectional study conducted on patients admitted to different ICUs with pulmonary edema, comprising 25 patients with CPE and 35 patients with ARDS. CUS, ECG, echocardiography, and chest radiograph were done for all patients. Results The mean age of patients with ARDS was 48.90±11.23 years, whereas the mean age of patients with CPE was 49.10±10.10 years. The majority of both groups were males. Systolic dysfunction and pneumonia were the most frequent etiology in CPE and ARDS, respectively. All patients in both groups had alveolar-interstitial syndrome. Pleural line, absence of lung sliding, and the spared area were presented in all cases with ARDS and absent in those with CPE. Moreover, none of those with CPE had lung pulse, but this finding was presented in 18 (51.4%) patients with ARDS. Conclusion CUS can help in differentiating ARDS from CPE in clinical practice. Based on CUS findings, absent or reduced lung sliding, pleural line abnormalities, and spared areas are diagnostic of ARDS. [ABSTRACT FROM AUTHOR]