The Role of Diaphragmatic Ultrasound as a Predictor of Extubation From Mechanical Ventilation
- Conditions
- Diaphragm Ultrasound
- Interventions
- Device: ultrasound
- Registration Number
- NCT05063526
- Lead Sponsor
- Beni-Suef University
- Brief Summary
Aim: To evaluate real-time ultrasound in the evaluation of diaphragmatic thickening, thickening fraction and or excursion to predict extubation outcomes. The investigators aimed to compare these parameters with other traditional weaning measures.
- Detailed Description
The diaphragm is an important respiratory muscle and dysfunction is very common in patients receiving mechanical ventilation. Diaphragm fatigue occurs even in patients who successfully pass the Spontaneous Breathing Test (SBT). Interrupting ventilation too early can lead to increased cardiovascular and respiratory pressure (CO2).retention and hypoxemia with up to 25% of patients requiring reinstitution of ventilator support. Unnecessary delays in liberation from mechanical ventilation also can be deleterious. Complications such as ventilator-associated pneumonia and ventilator-induced diaphragm atrophy can be seen with short periods of mechanical ventilation thereby prolonging mechanical ventilation. As SBT monitoring is insensitive to detect early signs of load-capacity imbalance. The evaluation of the diaphragmatic thickening fraction (DTF) may be also helpful to assess diaphragmatic function and its contribution to respiratory workload. Ultrasound can be used to detect the deflection of the diaphragm, which helps to identify patients with diaphragm dysfunction
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 120
-
Critically ill patients intubated for more than 48 hours who are ready for weaning with the following criteria.
- positive end-expiratory pressure (PEEP) ≤ 5 cm H2O.
- Fraction of inspired oxygen (FiO2) < 0.5.
- respiratory rate (RR) < 30 breaths/min.
- rapid shallow breathing index < 105, PaO2/FiO2 > 200.
-
Age< 65 years.
- Age<18 years.
- Patient with history of plural effusion, trauma to chest and history of mechanical ventilation for < 6 months.
- patient with neuromuscular diseases affect diaphragm .
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Group A ultrasound 40 patients on mechanical ventilation due to non-pulmonary disease at respiratory ICU had their diagnosis as follows: 24 (60%) had congestive heart failure, 4 (10%) had diabetes mellitus, 4 (10%) had sepsis other than pneumonia, 2 (5%) had epilepsy, 2 (5%) had embolic hemiplegia, and 4 (10%) had chronic renal failure. Out of group A patient, 9 patients (11.25%) had failed weaning of which 4 patients needed reintubation and 5 patients needed non-invasive positive ventilation of which 2 patients were reintubated and 3 patients died. control group. ultrasound 40 patients Chronic obstructive pulmonary disease (COPD) from Outpatient Clinic Group B ultrasound 40 patients who are mechanically ventilated due to pulmonary disease at respiratory ICU had their diagnosis as follows: 21 (53%) had COPD, 8 (20%) had asthma, 5 (13%) had bronchiectasis, 5 (13%) had pneumonia and 1 (3%) had viral influenza H1N1. Out of group B patients, 11 patients (13.75%) had failed weaning, of which 6 patients needed reintubation and 5 patients needed non-invasive positive ventilation of which 3 patients were re-intubated and 2 patients died.
- Primary Outcome Measures
Name Time Method diaphragmatic ultrasound thickening during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year Right diaphragmatic ultrasound measurement thickening in millimeter was made during tidal and deep breathing . patient is in the supine position and measurement of right diaphragm by M-mode and B-mode images
diaphragmatic ultrasound thickening fraction during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year Right diaphragmatic ultrasound measurement thickening fraction(percentage% ) was made during tidal and deep breathing . patient is in the supine position and measurement of right diaphragm by M-mode and B-mode images
diaphragmatic ultrasound excursion during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year Right diaphragmatic ultrasound measurement excursion( centimeter) was made during tidal and deep breathing . patient is in the supine position and measurement of right diaphragm by M-mode and B-mode images
- Secondary Outcome Measures
Name Time Method diaphragmatic ultrasound thickening fraction Up to 48 hours on T-tube, through study completion, an average of 1 year Differences in thickening fraction ( millimeter )between patients who are successfully and failed weaning .
diaphragmatic ultrasound thickening Up to 48 hours on T-tube, through study completion, an average of 1 year Differences in diaphragm thickening(percentage% )between patients who are successfully and failed weaning .
diaphragmatic ultrasound excursion Up to 48 hours on T-tube, through study completion, an average of 1 year Differences in diaphragm excursion ( centimeter) between patients who are successfully and failed weaning
Trial Locations
- Locations (1)
Beni-suef
🇪🇬Banī Suwayf, Mequbal, Egypt