Role of Diaphragmatic Ultrasound in predicting need for Postoperative Mechanical Ventilation after major Hepato-Pancreato-Biliary Procedures: A Prospective Observational Study
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 140
- 试验地点
- 1
- 主要终点
- Diaphragmatic weakness as assessed by ultrasound
研究概览
简要总结
| Studies have shown that the diaphragm can be significantly weakened postoperatively because it is fatigued during invasive mechanical ventilation. A measurement of the twitch frequency changes showed that there was an increased incidence of diaphragmatic weakness in patients having weaning failure. The American Thoracic Society and the European Respiratory Society have put forth a list of tests that can be performed on a patient to assess diaphragmatic functioning. These include subjective tests like measuring airway opening pressure during sniffing or cough by the patient. Other tests that measure the true respiratory effort exerted by an individual are called volitional tests. Ultrasound assessment of diaphragm is a more feasible modality due to widespread availability of portable ultrasound. |
In Diaphragmatic Evaluation approach , a high-frequency linear ultrasound probe, is applied below the nipple, at the anterior axillary line. In this approach A stands for axillary line, B stands for breathing as it is measured during breathing, and C stands for caudal direction in which the probe is moved to view the diaphragm. The thickness of the diaphragm and its ratio during inspiration and expiration show the amount of effort that is being exerted by the muscle. In normal individuals the change ranges from 28-96 percent and 35-5 percent in individuals with diaphragmatic paralysis.
So, perioperative assessment of diaphragm in patients undergoing major surgeries.
However, despite thorough search of literature we could not find any study where diaphragm function is assessed during surgery in such patients. So, this study aims to analyze the association of diaphragmatic weakness in patients posted for Hepato-Pancreato-Biliary surgery under general anaesthesia, with need for postoperative mechanical ventilation. We hypothesize that perioperative diaphragmatic weakness will result in significantly increased need for postoperative mechanical ventilation.
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
- •Patients aged more than 18 years, American society of Anaesthesia (ASA) class I to III, undergoing major hepato-pancreato-biliary procedures.
排除标准
- •Refusal to consent Patients with severely compromised lung function Patients with any known cardiac disease Patient already on mechanical ventilation Patients in shock or altered mental status.
结局指标
主要结局
Diaphragmatic weakness as assessed by ultrasound
时间窗: After the surgery
次要结局
- Change in the diaphragmatic function from the preoperative period to post-operative period(After the surgery)
- Change in the diaphragmatic function from the preoperative period to post-operative period with and without epidural(After the surgery)
- Correlation of the diaphragmatic function with the need for post-operative mechanical ventilation(After the surgery)
- Correlation of the diaphragmatic function with the lung ultrasound score and post-operative arterial blood gases (ABG).(After the surgery)
- Correlation of diaphragmatic function with patient outcomes(Till 28 days)
研究者
Deepak Singla
All India Institute of Medical Sciences Rishikesh