Efficacy Of Thoracic Fluid Content By Cardiometry in Predicting Weaning Failure In Icu.

Completed

Conditions: Respiratory failure, unspecified,

Registration Number: CTRI/2020/07/026864

Lead Sponsor: All India Institute of Medical Sciences

Brief Summary: Mechanical ventilation is provided in intensive care unit when the patient is unable to

maintain spontaneous respiration on their own in order to sustain life.Weaning is a process

of gradual liberalization from the ventilatorsupport after the resolution of primary illness.

Weaning failure is defined as failure in tolerating spontaneous breathing trial (SBT ) or the

need for invasive or non- invasive ventilation within 48 hours of extubation. Neuro-muscular

disease, nutritional deficiency,metabolic disturbance,Cardiac dysfunction and respiratory

disease are the various causes of weaning failure.

Liu et al, conducted a study in critically ill patients and found that weaning induced

pulmonary edema attributed to 40% of unsuccessful SBT.Although the patho-physiology of

weaning induced pulmonary edema remains complex ,transition from mechanical ventilator

support to spontaneous breathing leads to physiological changes like increased pre-load

,after - load ,work of breathing ,adrenergic tone and increased myocardial oxygen

consumption thereby leading to elevated pulmonary venous pressure and pulmonary edema

effectuating weaning failure.Patients with borderline left ventricular systolic and diastolic

function, Chronic obstructive pulmonary disease, especially with positive cumulative fluid

balance are at increased risk for weaning failure.Weaning failure results in prolonged

ventilatory demand , lengthened intensive care unit stay and hence increased morbidity

and mortality.Since the incidence of weaning failure remains high ,a profound knowledge

regarding the risk factors,pathogenesis ,prediction ,diagnosis and management of

weaning failure is very much essential to curtail it. Hence a detailed assessment done

before SBT, during and after SBT could help us in preventing weaning failure.

Lung ultrasound score (LUS) is a useful tool in predicting weaning failure. Higher baseline

LUS score and Loss of lung aeration during SBT are associated with high failure rates.A

LUS score < 13 % was associated with successful weaning. An integrated use of lung usg,

diaphragmatic thickness fraction and trans -thoracic echo has shown a promising role in

predicting weaning failure .Since there is no ideal single parameter to predict weaning

failure, a combination of methods is essential to assess neurology ,cardiovascular and

respiratory status.

Recently Thoracic fluid content, a novel parameter which measures the whole fluid

(intravascular,extravascular)component in the thoracic cavity is analysed in predicting

weaning failure.A higher TFC value is associated with increased lung congestion and

hypervolemia, which is considered as a risk factor for difficult weaning.Thoracic fluid content

has advantages like easy measurement by the physician and paramedics, lack of inter-

observer variations because of minimal fluctuations in the numerical value.

We hypothesize that Thoracic fluid content measured by cardiometry has a promising role

and can be used as an adjuvant non invasive tool in predicting weaning failure.Hence in our

study we combine measuring the Thoracic fluid content along with Lung utrasound score

Echocardiography, Pulmonary vascular permeability index and Extravascular lung water

index to ascertain the efficacy of thoracic fluid content measured by cardiometry in

predicting weaning failure .

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 60

Inclusion Criteria

1.Patients consenting for the study 2.Patients mechanically ventilated for more than 48 hours.
3.All patients considered eligible for a SBT by the attending physician as per standard ICU protocol: FiO2 < 0.5, PEEP â‰¤ 5 cm H2O, PaO2 /FiO2 > 200, respiratory rate <30 breaths per minute, absence of fever, alert and cooperative, and hemodynamic stability in the absence of high doses of vasopressor therapy.

Exclusion Criteria

1.Patients on short term mechanical ventilation in the immediate postoperative period.
2.Patients aged <18 years 3.Patients with spinal cord injury above T8 level 4.Presence of significant cardiac arrhythmia 5.Patients with diaphragmatic paralysis 6.Patients planned for prophylactic noninvasive ventilation after extubation.
7.Patients in whom a suitable ultrasonographic image could not be obtained for lung, diaphragm and cardiac measurements.

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
1.To assess if the thoracic fluid content (TFC) measured at the beginning of SBT by	To Assess before spontaneous breathing trial and within 48hours of spontaneous breathing trial
cardiometry can predict weaning success or failure.	To Assess before spontaneous breathing trial and within 48hours of spontaneous breathing trial

Secondary Outcome Measures

Name	Time	Method
1.To assess if the lung ultrasound score, echocardiographic parameters and NT Pro BNP measured before SBT either alone or in combination can predict weaning failure.	2.To assess the correlation between TFC and extravascular lung water index(EVLWI)

Trial Locations

Locations (1): All India Institute of Medical Sciences
🇮🇳
West, DELHI, India
All India Institute of Medical Sciences
🇮🇳West, DELHI, India
Karthik Ram A
Principal investigator
8870249190
drakarthikram@gmail.com