Integrated Multi-system Ultrasound in Intensive Care critical practice

Weaning from invasive mechanical ventilation is a challenging process. Despite a substantial weaning failure rate of approximately 20–30%, standardized criteria to guide weaning practices remain poorly defined. The etiology of weaning failure is inherently multifactorial, arising from a complex interplay of respiratory and cardiovascular pathophysiological changes during spontaneous breathing trials (SBT), alongside neuromuscular impairment, specifically diaphragmatic dysfunction. Optimizing weaning outcomes depends on early recognition of the potential source of risk and the timely implementation of appropriate management. Notably, weaning -induced cardiac dysfunction (WICD) accounts for nearly one third of these failures and growing evidence suggests that left ventricular diastolic dysfunction (DD) is a significant determinant for weaning outcomes. In this context, the integration of multisystem ultrasonography-based assessment has gained a substantial clinical traction regarding identification of underlying mechanisms of failure and prognostic implications. Lung aeration, diaphragmatic thickening fraction and its excursion and assessing ventricular function have been collectively investigated. This comprehensive approach facilitates the real-time identification of dynamic physiological derangements during the SBT and guides toward targeted therapeutic interventions, and accordingly it enables a seamless transition to a successful liberation from mechanical ventilation. While current literature focuses on the role of US integration in predicting weaning failure related to DD, this predominant focus on the left side DD overlooks the impact of systemic venous congestion, increased venous return and elevated right ventricular afterload triggered by transition to SBT. The venous excess ultrasound (VEXUS) score is an emerging ultra-sound-based tool to assess flow pulsatility across the hepatic, portal and renal veins which serve as surrogate markers of systemic venous intolerance. To date, the integration of systemic venous hemodynamics into weaning protocols has not been fully explored. This study aims to evaluate whether a multisystem ultrasound bundle, integrating VEXUS with other ultrasonographic cardiopulmonary and diaphragmatic metrics, provides better prediction of weaning outcomes than current conventional readiness to wean practice.