• Mathangi Krishnakumar, Radhakrishnan Muthuchellappan, and Dhritiman Chakrabarti.
• Department of Neuroanaesthesia and Neurocritical Care, III Floor, Neurosciences Faculty Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India. mathz89@gmail.com.
• Neurocrit Care. 2021 Apr 1; 34 (2): 382-389.

IntroductionThe optimal time to discontinue patients from mechanical ventilation is critical as premature discontinuation as well as delayed weaning can result in complications. The literature on diaphragm function assessment during the weaning process in the intriguing subpopulation of critically ill neuromuscular disease patients is lacking.MethodsPatients with neuromuscular diseases, on mechanical ventilation for more than 7 days, and who were ready for weaning were studied. During multiple T-piece trials over days, diaphragm function using ultrasound and diaphragm electrical activity (Edi peaks using NAVA catheter) was measured every 30 min till a successful 2 h weaning.ResultsA total of 18 patients were screened for eligibility over 5-month period and eight patients fulfilled the inclusion criteria. Sixty-three data points in these 8 subjects were available for analysis. A successful breathing trial was predicted by Edi reduction (1.22 μV for every 30 min increase in weaning duration; 0.69 μV for every day of weaning) and increase in diaphragm excursion (2.81 mm for every 30 min increase in weaning duration; 2.18 mm for every day of weaning).ConclusionThe Edi and diaphragm excursion changes can be used as additional objective tools in the decision-making of the weaning trials in neuromuscular disease.

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