Ultrasound of Diaphragmatic Musculature in Mechanically Ventilated Patients.
- Conditions
- Mechanical Ventilation
- Interventions
- Other: Pressure support mode (PS)Other: Pressure controlled mandatory ventilation mode (P-CMV)Other: Pressure synchronized intermittent mandatory ventilation
- Registration Number
- NCT03281785
- Lead Sponsor
- Mansoura University
- Brief Summary
Muscle weakness and dysfunction are common problems in patients hospitalized in the intensive care unit. Respiratory muscle weakness during mechanical ventilation was recognized a state of muscular fatigue. The terminology 'ventilator-induced diaphragmatic dysfunction' (VIDD) originally was introduced to describe these effects of mechanical ventilation and respiratory muscle unloading on the diaphragm.
Ultrasonography is becoming increasingly popular management of ICU patients. It is a simple, non-invasive and safe imaging technique that can be used for the assessment of distinctive diaphragmatic characteristics.
Parameters such as amplitude and velocity of contraction, which can be assessed using M-mode ultrasound. In addition, static and dynamic (thickening fraction during inspiration) diaphragmatic thickness can also be measured by ultrasonography.
- Detailed Description
The aim of this study is to evaluate the effect of different modes of mechanical ventilation on diaphragmatic thickness using ultrasonography and the relation between time of mechanical ventilation and the percentage of change of diaphragmatic thickness in head trauma patients subjected for mechanical ventilation (\>2 days) intensive care unit.
Modes of ventilation will be used in the study are:
* Pressure controlled mandatory ventilation mode (P-CMV).
* Pressure synchronized intermittent mandatory ventilation mode (P-SIMV).
* Pressure support (PS) mode.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Male
- Target Recruitment
- 93
- American Society of Anesthesiologists (ASA) physical status grades I and II.
- Glasgow coma scale < 8.
- Selections of patients need mechanical ventilation (>2 days).
- Head trauma patients.
- History of diaphragmatic disease
- Neuromuscular disease
- Anatomical malformation of the diaphragm.
- Patients with chest disease
- Diabetic patients.
- Chest trauma
- Chest malignancy.
- Use of non-invasive ventilation before the start of invasive ventilation.
- Selection of patients of short period of mechanical ventilation (< 2 days).
- Hemodynamic instability.
- Morbid obesity (body mass index > 40 kg/m2).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Pressure support mode (PS) Pressure support mode (PS) Patents will be ventilated with pressure support mode (PS) Pressure controlled mandatory ventilation mode (P-CMV) Pressure controlled mandatory ventilation mode (P-CMV) Patients will be ventilated using pressure controlled mandatory ventilation mode Pressure synchronized intermittent mandatory ventilation Pressure synchronized intermittent mandatory ventilation Patients will be ventilated using pressure synchronized intermittent mandatory ventilation mode (P-SIMV)
- Primary Outcome Measures
Name Time Method Diaphragmatic thickness for 3 weeks after initiation of mechanical ventilation changes in diaphragmatic thickness from baseline to nadir
- Secondary Outcome Measures
Name Time Method Liver function for 3 weeks after admission to the ICU Glasgow coma scale (GCS) for 2 weeks after initiation of mechanical ventilation. Mean blood pressure for 3 weeks after admission to the ICU Heart rate for 3 weeks after admission to the ICU Central Venous Pressure for 3 weeks after admission to the ICU mode of ventilation for 3 weeks after initiation of mechanical ventilation tidal volume for 3 weeks after initiation of mechanical ventilation The relation between time of mechanical ventilation and the percentage of change of diaphragmatic thickness for 3 weeks after initiation of mechanical ventilation measurement of the diaphragmatic thickness as usual and calculate the percentage of change of the diaphragmatic thickness over the time of mechanical ventilation
Sequential organ failure assessment (SOFA) score for 3 weeks after admission to the ICU Renal function tests for 3 weeks after admission to the ICU Coagulation profile for 3 weeks after admission to the ICU temperature for 3 weeks after admission to the ICU respiratory rate for 3 weeks after initiation of mechanical ventilation airway pressure for 3 weeks after initiation of mechanical ventilation peak and mean airway pressure
ICU stay for 3 weeks after initiation of mechanical ventilation Time from admission to the ICU untill discharge or death
Duration of mechanical ventilation for 3 weeks after initiation of mechanical ventilation time from initiation of mechanical ventilation till extubation or death
Complete blood picture for 3 weeks after admission to the ICU Arterial Oxygen Saturation for 3 weeks after admission to the ICU
Trial Locations
- Locations (1)
Mansoura University, Faculty of Medicine
🇪🇬Mansourah, DK, Egypt