ROLE OF PARASTERNAL INTERCOSTAL MUSCLE ULTRASOUND DURING WEANING FROM MECHANICAL VENTILATION AND PREDICTION OF EXTUBATION SUCCESS IN ICU – A PROSPECTIVE OBSERVATIONAL STUDY
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 60
- 试验地点
- 1
- 主要终点
- To determine whether the parasternal intercostal muscle thickening fraction measured by ultrasonography is useful in predicting weaning outcomes.
研究概览
简要总结
The research to predict whether patients in mechanical ventilation can be successfully liberated or not, active and still incomplete. The process of weaning and liberation from mechanical ventilation is physiologically complex and involves an interplay of lung parenchyma, respiratory muscle strength and cardiac reserve. Each of the factors has been shown to affect the weaning process. Respiratory muscle strength is usually assessed by diaphragm strength. But in some cases like abdominal surgery, diaphragm injury or repair this might not be possible.
We aim use to use the intercostal muscle function assessment as a tool to predict extubation sccess. The intercostal muscles will be assessed by their thickening during inspiration. If the diaphragm is weak or dysfunctional the intercostal muscles may overcompensate and may indicate weaning failure. They may also be overactive with lung parenchymal and cardiac dysfunction. The intercostal muscles will be assessed in the parasternal location and will be assessed before and after a spantaneous breathing trial
We also aim to develop a composite index made up of respiratory muscle strength, cardiac systolic/diastolic parameters and lung ultrasound score (to assess lung parenchyma), to predict weaning outcome.
研究设计
- 研究类型
- Observational
入排标准
- 年龄范围
- 18.00 Year(s) 至 65.00 Year(s)（—）
- 性别
- All
入选标准
- •1.Age > 18 years 2.Duration of mechanical ventilation >48 hrs.
- •3.Eligible for a spontaneous breathing trial as decided by the intensivist, according to established guidelines.
排除标准
- •1.Pregnancy 2.Patients with spinal cord injury at or above T12 3.Presence of significant arrhythmias 4.Patients with diaphragmatic paralysis/injury 5.Planned extubation into non-invasive ventilation / High flow nasal cannula (HFNC) 6.Surgical dressing significantly interfering with ultrasonography.
结局指标
主要结局
To determine whether the parasternal intercostal muscle thickening fraction measured by ultrasonography is useful in predicting weaning outcomes.
时间窗: Parameters noted before and after a 30 minute spontaneous breathing trial. Outcome assessed after forty eight hours of planned extubation
次要结局
- To determine the possibility of a composite index made up of echocardiographic parameters of systolic/diastolic cardiac function, ultrasound parameters of respiratory muscle function and LUS score, before and after SBT for predicting weaning outcomes(Parameters noted before a spontaneous breathing trial and after the spontaneous breathing trial, if successful. Outcome assessed after forty eight hours of planned extubation)
- To observe the role of abdominal muscles in weaning process.(Parameters noted before a spontaneous breathing trial and after the spontaneous breathing trial, if successful. Outcome assessed after forty eight hours of planned extubation)
- To assess various combinations of parameters and their ability to predict weaning outcomes.(Parameters noted before a spontaneous breathing trial and after the spontaneous breathing trial, if successful. Outcome assessed after forty eight hours of planned extubation.)
- 4.To study other variables during ICU stay associated with weaning outcomes.(Parameters noted before a spontaneous breathing trial and after the spontaneous breathing trial, if successful. Outcome assessed after forty eight hours of planned extubation)