WEANING DIFFICULTY...What can I do?. ROLE OF THE ECOGRAFY IN THE DISSOLUTION OF MECHANICAL VENTILATION. Beatriz Bellón López De Antón-Bueno (1), Sara López Palanca (2), Eva Mateo Rodriguez (3). General University Hospital of Albacete(1), Almansa General Hospital (2), General University Hospital Consortium of Valencia (3). 
INTRODUCTION: 
Ultrasonography has been consolidated as an essential tool to assess cardiopulmonary insufficiency in critical care areas, offering innovative applications, such as its potential utility in the weaning process of mechanical ventilation, not only allowing an assessment of lung function, but also of the cardiac, diaphragmatic and quantification functions of pleural effusion. 
CASE DESCRIPTION: 
A 72-year-old man with a history of left lower lobectomy, severe COPD and severe ventricular dysfunction admitted to a resuscitation unit for polytrauma after aggression. In the lesion balance after Total-Body CT, TBI was assessed with SAH and bilateral contusive foci, fracture of nasal bones, right lung contusion with fracture of 2-6 right costal arches and mild hepatic contusion. 
EVOLUTION: 
The patient arrives at a resuscitation unit in spontaneous ventilation, requiring orotracheal intubation due to a drop in the GCS score and respiratory failure. Important difficulty in weaning mechanical ventilation with percutaneous tracheostomy at the 10th day of admission due to prolonged MV prediction. Outstanding in the evolution is the appearance of repeated right pleural effusions and left atelectasis. The daily evaluation of the chest radiography does not meet drainage criteria (according to thoracic surgery), and a right lung ultrasound is performed, where it is objective and draining up to 1500 ml on several occasions. After evaluation of the cardiac function by means of echocardiography, diaphragmatic echography by diaphragmatic echography and resolution of the pulmonary condition, the patient is decannulated and discharged to the plant at 40 days of admission. 
DISCUSSION: 
In usual practice, both physiology and known causes of weaning failure support the use of ultrasound to identify those patients who are at high risk of failure, so as to optimize physiological function, thus improving the probability of interruption with successful ventilatory support. The 4 pillars to be studied are cardiac, diaphragmatic, pulmonary parenchyma and pleural effusion. 
CONCLUSIONS: 
• Failure to wean mechanical ventilation is multifactorial; There is a complex interrelationship between pulmonary and cardiac dysfunction. • We emphasize ultrasound as an essential tool for assessing cardiopulmonary insufficiency in critical care units. • Potential utility in the mechanical ventilation weaning process. 
          
BIBLIOGRAFHY: 
•Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung. P.Mayo, G.Volpicelli, N.Lerolle, A.Schreiber, P.Doelken and A.Vieillard-Baron. Intensive Care Med 2016. 
•Ecografía pulmonar básica. Parte 2. Patología parenquimatosa. F.B. de la Quintana Gordon, B. Nacarino Alcorta y M. Fajardo Pérez. Rev Esp Anestesiol Reanim. 2015;62(6):337-349 
•Lung ultrasound to predict mechanical ventilation weaning failure. L Y Delgado Ayala, OTorres, A Sanchez- Calzada, JL NavarroA Torres, R Gastelum, P Romano Albornoz, M Arcos, EE Monares, J Aguirre, J Franco. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A317.

Weaning difficulty...what can I do? Role of the ecografy in the dissolution of mechanical ventilation