Extubation Guided by Bedside Ultrasound

Prolonged mechanical ventilation is likely to lead to respiratory complications, such as pneumonia, pulmonary edema, atelectasis, pulmonary barotrauma, acute respiratory distress syndrome, etc. The duration of mechanical ventilation after major abdominal surgery in elderly patients was longer, the lung function reserve decreased significantly, and the incidence of postoperative lung complications was as high as 53.1%. Therefore, it is of great clinical significance and social value to accurately grasp the ventilator withdrawal time of elderly patients after surgery and reduce ventilator-related lung injury.In recent years, pulmonary ultrasound has been more and more applied to the lung function assessment of critically ill patients in intensive care unit, while the study of early postoperative extubation guided by bedside lung ultrasound in critically ill patients remains to be explored. Combined with previous work and related literature, our research group planned to conduct a multi-center prospective clinical trial to evaluate the recovery of lung function in elderly patients by using lung ultrasound score (LUS), diaphragm mobility (DD) combined with oxygenation index (OI), and to guide elderly patients undergoing gastrointestinal surgery to perform early extubation in PACU, so as to reduce postoperative ventilators associated lung injury in elderly patients. The application of ERAS concept in abdominal operation of the elderly in this project can effectively reduce the occurrence of postoperative pulmonary complications, accelerate postoperative recovery and rehabilitation of patients, and shorten the length of hospital stay, which has important clinical and social value.

Inclusion Criteria:Age ≥65 years old, gender unlimited;Ventilator assisted ventilation after endotracheal intubation;Surgery under general anesthesia;mechanical ventilation time ≥3h;Successfully passed the spontaneous respiration test (SBT);Exclusion Criteria:airway stenosis, airway compression;Large area of chest skin damage and burn;central respiratory failure;Severe myasthenia and no autonomic diaphragm activity;patients with unplanned extubation;Patients with end-stage cardiopulmonary disease.