Tissue Doppler Ultrasound During Spontaneous Breathing and Non-invasive Ventilation in the Post-extubation Period.
- Conditions
- Non-invasive VentilationAcute Respiratory Failure
- Interventions
- Other: Post-extubation TDI
- Registration Number
- NCT03978221
- Lead Sponsor
- Azienda Ospedaliero Universitaria Maggiore della Carita
- Brief Summary
The aim of the present investigation will be to evaluate diaphragmatic excursion velocity during non-invasive ventilation and spontaneous breathing at both inspiration and expiration.
this analysis will be performed through diaphragmatic tissue Doppler assessment.
- Detailed Description
Early weaning from invasive ventilation, in patients admitted to intensive care, is associated with a marked reduction in ventilator-associated pneumonia, length of stay in intensive care unit and hospital, total duration of mechanical ventilation and decrease in overall mortality. Moreover, in case of need of protected extubation, non-invasive ventilation has allowed to prevent re-intubation and decrease hospital mortality compared to the simple administration of oxygen through a facial mask, in particular when applied immediately after extubation.
The diaphragmatic tissue doppler imaging (TDI) is an ultrasonographic technique derived from ultrasound evaluation of the heart's motility. It can be easily used on the diaphragm to calculate the speed of muscles displacement that could be associated with patient's respiratory drive.
The aim of the study is the evaluation of the diaphragmatic excursion velocity variations using diaphragmatic tissue doppler, measured in venturi mask and non-invasive ventilation in the post-extubation period, in order to compare the diaphragm stress variations during the two different modes.
Method Patients after extubation will be randomly submitted to a spontaneous breathing test in venturi mask and in facemask or helmet NIV.
Each trial will last 20 minutes. During the last minute of each trial a tissue doppler diaphragm examination will be performed to assess the speed speed of muscle displacement, acceleration and deceleration.
Inclusion criteria: invasive mechanical ventilation \> 24h with consequent extubation.
Exclusion criteria: refusal to grant consent, pregnancy, age \< 18 years, haemodynamic instability, difficult management of secretions, required inotropic and / or vasoactive drugs at high doses.
During the study, vital parameters will be given.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 20
- invasive mechanical ventilation > 24h with consequent extubation
- refusal to grant consent
- pregnancy
- age >18 years
- haemodynamic instability
- difficult management of secretions
- required inotropic and / or vasoactive drugs at high doses
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description diaphragmatic tissue doppler evaluation Post-extubation TDI A tissue Doppler evaluation, using a sectorial probe, will be performed by analyzing the diaphragmatic displacement velocity during inspiration and expiration randomly assessed in spontaneous breathing with Venturi Mask and in Non-invasive ventilation with a helmet or facial mask
- Primary Outcome Measures
Name Time Method diaphragmatic displacement velocity through each trial completion, an average of 20 minutes Inspiratory and expiratory diaphragmatic displacement velocity evaluated with tissue doppler during the NIV trial and in spontaneous breathing with Venturi mask.
- Secondary Outcome Measures
Name Time Method Diaphragmatic acceleration through each trial completion, an average of 20 minutes Inspiratory and expiratory diaphragmatic displacement acceleration evaluated with tissue doppler during the NIV trial and in spontaneous breathing with Venturi mask.
Gas exchange - arterial carbon dioxide tension through each trial completion, an average of 20 minutes PaCO2, will be obtained performing ABG sample
Gas exchange - pH through each trial completion, an average of 20 minutes pH will be obtained performing ABGs.
Gas exchange - arterial oxygen tension through each trial completion, an average of 20 minutes arterial oxygenation PaO2 will be obtained performing ABGs.
Dyspnea level through each trial completion, an average of 20 minutes dyspnea level evaluated through visual analogical scale ( VAS dyspnea)
Comfort level through each trial completion, an average of 20 minutes Comfort level evaluated through Comfort Scale
Hemodynamic parameters, Heart Rate (HR) athrough each trial completion, an average of 20 minutes Heart Rate (HR)
Blood Pressure (BP) through each trial completion, an average of 20 minutes invasive Mean arterial Blood Pressure
Trial Locations
- Locations (1)
A.O.U Maggiore della Carità
🇮🇹Novara, Italy