Predictive value of diaphragmatic kinetics using tissue doppler imaging in weaning of patients from mechanical ventilation- An observational, prospective cohort study
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 150
- 试验地点
- 1
- 主要终点
- Correlation of diaphragmatic kinetics (Peak contraction velocity, peak relaxation velocity, velocity time integral, maximal relaxation rate) with weaning
研究概览
简要总结
Weaning from mechanical ventilation is a challenging step during recovery from critical illness. Weaning failure or early reintubation are associated with increased morbidity and mortality, exposing patients to life-threatening complications. Weaning from mechanical ventilation involves change of positive pressure ventilation to negative pressure ventilation during spontaneous breathing trail (SBT)
Diaphragm function is an important determinant of successful liberation from ventilation and recovery from critical illness. Invasive mechanical ventilation causes progressive decline in diaphragm bulk and strength in a phenomenon called ventilator induced diaphragm dysfunction [VIDD].
Our hypothesis is that diaphragmatic kinetic parameters differ between patients who have successful weaning as compared to patients with weaning failure and thus, diaphragmatic tissue doppler imaging (TDI) variables can be used as an adjuvant to spontaneous breathing trial (SBT).
Ultrasound is easily available in all the intensive care units. It is non-invasive, with no radiation effects, patient and intensivist friendly, can be repeated multiple times if necessary.Patient safety is not compromised and can be done at bed side. Patient need not be shifted out of ICU for any assessment. Patients who are ≥ 18 years, on mechanical ventilation for more than 12 h and meeting all of the following criteria for the SBT are included
On each TDI waveform following parameters will be identified and measured –Peak contraction velocity (PCV),Velocity–time integral (VTI), Peak relaxation velocity (PRV),Maximal relaxation rate (MRR)
Objective is to compare diaphragmatic kinetics using tissue doppler imaging (peak contraction velocity, velocity time integral, peak relaxation velocity, maximal relaxation rate) in patients who had a successful weaning versus patients who had a weaning failure.
研究设计
- 研究类型
- Observational
入排标准
- 年龄范围
- 18.00 Year(s) 至 80.00 Year(s)（—）
- 性别
- All
入选标准
- •(1) Age ≥ 18 years (2) On mechanical ventilation for more than 12 h (3) Meeting all of the following criteria for the SBT: a.FiO2<40% b.Positive end-expiratory pressure ≤5 cmH2O c.Respiratory rate≤30 breaths/min d.Haemodynamic stability in the absence/ minimal vasopressors.
排除标准
- •1.Age <18 years 2.Neuromuscular diseases 3.Flail chest or multiple rib fracture 4.Morbid obesity (BMI> 40 kg/m2) 5.Inability to obtain a clear TDI signal of the right hemidiaphragm 6.Pregnant patient.
- •7.Tracheostomised patient.
结局指标
主要结局
Correlation of diaphragmatic kinetics (Peak contraction velocity, peak relaxation velocity, velocity time integral, maximal relaxation rate) with weaning
时间窗: Just before the Spontaneous Breathing Trial.
次要结局
- Incidence of reintubation within 48 hours of extubation.(Within 48 hours of extubation.)