Prospective insights into diaphragmatic function and weaning outcomes in mechanically ventilated ICU patients: A Point of Care ultrasound approach

Study title and design

Prospectie longitudinal obserational study assessing diaphragmatic function using point of care ultrasound in mechanically ventilated adult ICU patients

Objectives

To evaluate serial changes in  diaphragmatic thickness thickening fraction and excursion during the first 5 ICU days

Compare the effects of volume controlled versus pressure controlled ventilation

Study the association between driing pressure and diaphragmatic dysfunction and determine whether early diaphragmatic dysfunction predicts difficult or prolonged weaning

Rationale

Mechanical ventilation is associated with ventilator induced diaphragmaic dysfunction which contritubes to delayed weaning prolonged ICU stay and worse clinical outcomes

There is limited prospective Indian data describing the trajectory of diaphragmatic function during mechanical ventilation and its impact on weaning outcome

This study aims to address this gap and support early risk stratification and optmisation of of ventilator strategies

Participants

Adult patients aged 18 years and above requiring  invasive mechanical ventilation for more than 72  hours with ICU stay atleast 5 days

Patient with pre existing neuromuscular disease diaphramatic pathology technical limitation to ultrasound or refusal of consent will be excluded

MethodsEligible patients will be enrolled within 24 hours of initiation of mechanical ventilation. Baseline demographic data illness severity score SOFA and APACHE II ventilator parameter laboratory values and nutritional intake will be recorded daily.Daily point of care ultrasound assessments from day 1  to day 5 will include diaphragmatic thickness thickening fraction, excursion tissue doppler indices and peripheral muscle thickness.Weaning outcomes duration of ventilation ICU length of stay and mortality will be documented. No additional interentions or biological sampling will be perfomed.Outcomes

The primary outcome is the rate of change in diaphragmatic function over the first 5 days of mechanical ventilation

Secondary outcomes include the effect of ventilatory mode and driving pressure on diaphragmatic function prediction of weaning outcomes and  correlation  with  duration of ventilation ICU stay mortality and peripheral muscle  wasting