Serial Ultrasonographic Evaluation Of Diaphragm Thickness During Mechanical Ventilation In ICU Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 61
- 试验地点
- 1
- 主要终点
- US measurement of diaphragm and quadriceps thickness
研究概览
简要总结
When a person is put on a breathing machine the investigators think that the breathing muscles can get weaker. The investigators are not sure how quickly this happens but in some people this leads to problems when they try to breathe on their own without the breathing machine. The diaphragm is at the bottom of a person's chest separating their lungs from what is in their belly and it is a very strong muscle. In fact, it is main muscle that one uses for breathing.
An ultrasound machine is a painless way to see what is happening beneath the skin. It is safe and easy to do. Using an ultrasound the investigators are planning to measure how thick the diaphragm is and how much it changes while a person is on a breathing machine in the ICU.
Getting a better understanding of this condition could lead to improved treatments that might help support patients who require a ventilator for breathing.
The investigators hypothesis is that patients for whom the breathing machine is doing all of the work of breathing, will have their diaphragm thickness gradually decrease and changing to a breathing modem mode where they have to put in more effort the diaphragm thickness will start increasing again.
详细描述
The investigators propose to expand the investigators single-centre longitudinal pilot study into a complete study in which the investigators will use B-mode ultrasonography to evaluate daily changes in diaphragm thickness in all critically ill patients on mechanical ventilation (MV) until successful weaned from MV. The impact of patient age, co-morbidities, and the use of various modes of ventilation on diaphragm thickness will be assessed. Diaphragmatic thickness and its change from baseline will be evaluated as predictors of the need for a prolonged wean (>7days).
The investigators hypothesize that in patients on mandatory mode ventilation, diaphragmatic thickness will progressively decrease. Switching from mandatory to assisted breathing modes will correlate with increases in diaphragmatic thickness.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 19 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients age ≥19 years in the ICU on ventilation
排除标准
- •History of diaphragmatic or neuromuscular disease
- •On a home ventilator
- •History of diaphragm surgery
- •Absence of adequate initial US images (3 consecutive days with at least 2 operators)
- •BMI greater than 40
结局指标
主要结局
US measurement of diaphragm and quadriceps thickness
时间窗: Participants will be ultrasounded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution
Diaphragm thickness will be measured once per day and continue until extubation, liberation from mechanical ventilation, transfer to another facility, death, or study completion.
次要结局
- Quadriceps muscle thickness(Participants will be ultrasounded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
- re-intubated within 48 hours(followed for 48 hours post extubation, or 3 month study period has ended)
- mean daily FiO2 (oxygen level administered)(Will be recorded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
- mean daily fluid balance(Will be recorded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
- presence of sepsis/severe sepsis on admission(from admission information, at the time of admission to the ICU, obtained from the patient record.)
- Initial presence of malnutrition(Measure at the time of admission to the ICU)
- paralytics given(Will be recorded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
- Body Mass Index (BMI)(from admission information, at the time of admission to the ICU, obtained from the patient record)
- At risk for re-feeding syndrome(Assessed on admission to the ICU)
- PEEP (Postive end expiratory pressure) applied by the mechanical ventilator at the time of the ultraspound(Participants will be ultrasounded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
- 30 day mortality(30 days after patient is extubated, or at the end of the follow up period 1 month after the 3 month study has ended)
- mode of mechanical ventilation for >80% of the day(Will be recorded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
- steroids given(Will be recorded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
- vasopressors given(Will be recorded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
- % Caloric goals met in preceding 24 hours(Will be recorded daily until they are extubated or the 3 month study period has ended, the expected average duration of mechanical ventilation is 4.4 days at our institution)
研究者
Steve Reynolds
Head and Research Director, Department of Critical Care, Royal Columbian Hospital
Fraser Health