The utility of intercostal respiratory muscle ultrasound scanning to predict which patients can be taken off the ventilator and its ability to identify patients who succeed in remaining off ventilatory support.

Completed

Conditions: Acute respiratory failure,

Registration Number: CTRI/2020/07/026427

Lead Sponsor: All India Institute of Medical Sciences

Brief Summary: The research to predict whether patients in mechanical ventilation can be successfully liberated or not, active and still incomplete. The process of weaning and liberation from mechanical ventilation is physiologically complex and involves an interplay of lung parenchyma, respiratory muscle strength and cardiac reserve. Each of the factors has been shown to affect the weaning process. Respiratory muscle strength is usually assessed by diaphragm strength. But in some cases like abdominal surgery, diaphragm injury or repair this might not be possible.

We aim use to use the intercostal muscle function assessment as a tool to predict extubation sccess. The intercostal muscles will be assessed by their thickening during inspiration. If the diaphragm is weak or dysfunctional the intercostal muscles may overcompensate and may indicate weaning failure. They may also be overactive with lung parenchymal and cardiac dysfunction. The intercostal muscles will be assessed in the parasternal location and will be assessed before and after a spantaneous breathing trial

We also aim to develop a composite index made up of respiratory muscle strength, cardiac systolic/diastolic parameters and lung ultrasound score (to assess lung parenchyma), to predict weaning outcome.

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 60

Inclusion Criteria

1.Age > 18 years 2.Duration of mechanical ventilation >48 hrs.
3.Eligible for a spontaneous breathing trial as decided by the intensivist, according to established guidelines.

Exclusion Criteria

1.Pregnancy 2.Patients with spinal cord injury at or above T12 3.Presence of significant arrhythmias 4.Patients with diaphragmatic paralysis/injury 5.Planned extubation into non-invasive ventilation / High flow nasal cannula (HFNC) 6.Surgical dressing significantly interfering with ultrasonography.

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To determine whether the parasternal intercostal muscle thickening fraction measured by ultrasonography is useful in predicting weaning outcomes.	Parameters noted before and after a 30 minute spontaneous breathing trial. Outcome assessed after forty eight hours of planned extubation

Secondary Outcome Measures

Name	Time	Method
To determine the possibility of a composite index made up of echocardiographic parameters of systolic/diastolic cardiac function, ultrasound parameters of respiratory muscle function and LUS score, before and after SBT for predicting weaning outcomes	Parameters noted before a spontaneous breathing trial and after the spontaneous breathing trial, if successful. Outcome assessed after forty eight hours of planned extubation
To observe the role of abdominal muscles in weaning process.	Parameters noted before a spontaneous breathing trial and after the spontaneous breathing trial, if successful. Outcome assessed after forty eight hours of planned extubation
To assess various combinations of parameters and their ability to predict weaning outcomes.	Parameters noted before a spontaneous breathing trial and after the spontaneous breathing trial, if successful. Outcome assessed after forty eight hours of planned extubation.
4.To study other variables during ICU stay associated with weaning outcomes.	Parameters noted before a spontaneous breathing trial and after the spontaneous breathing trial, if successful. Outcome assessed after forty eight hours of planned extubation

Trial Locations

Locations (1): All India Institute of Medical Sciences
🇮🇳
South, DELHI, India
All India Institute of Medical Sciences
🇮🇳South, DELHI, India
Dr Puneet Khanna
Principal investigator
9873106546
k.punit@yahoo.com