Acute Respiratory Distress, Septic Shock
Conditions
Keywords
Mechanical Ventilation
Brief summary
Ventilatory support during critical phase result in inactivity of respiratory muscles especially diaphragm muscle. These inactivity also result in change of contractile capability and quick muscular atrophy. The aim of the study is to visualize the evolution of diaphragm thickness by echography during Mechanical Ventilation for patients with septic shock or acute respiratory distress syndrome and to compare with the evolution for patients under non-invasive ventilation and those with spontaneous ventilation. Measurements will be performed at day 1, day 5 and day 10 (if patient still under a mode of ventilation or in the unit). The evolution of diaphragm thickness will also be compared to pectoralis muscle atrophy, which is not involved in ventilation, in order to assess respective effect of ventilatory inactivity and undernutrition linked to intensive care.
Interventions
DEVICEUltrasound
An ultrasound of the right diaphragm will be performed on day 1, day 3, day 5 and day 10
OTHERNeuromyopathy score
A neuromyopathy score will be assessed on the extubation day
OTHERRespiratory performances
An assessment of the respiratory performances will be done on the extubation day, including higher expiratory pressure, higher inspiratory pressure, and occlusion pressure
Sponsors
Centre Hospitalier Saint Joseph Saint Luc de Lyon
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years old * Group 1 : under Mechanical Ventilation (time of Mechanical Ventilation for at least 5 days) * Group 2 : under Non-invasive Ventilation * Group 3 : Spontaneous Ventilation * Non opposition of patient (Groups 2 and 3) or non-opposition of patient family member (Group 1)
Exclusion criteria
* Known diaphragmatic paralysis * Neurologic pathology with motor deficit * Pregnancy or breast-feeding woman
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from day 1 diaphragm thickness at day 3 and day 5 | 1 day, 3 days and 5 days after introduction of Mechanical Ventilation | Diaphragm thickness measured by ultrasound |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Type of ventilatory support | 10 days after start of ventilatory support | Define which type of ventilatory support is used (mechanical ventilation, non-invasive ventilation, or spontaneous ventilation) |
| Ventilatory mode | 10 days after start of ventilatory support | Ventilatory mode (controlled ventilation, pressure support ventilation) |
| Pectoralis muscle thickness measured by ultrasound | 10 days after start of ventilatory support | To compare the importance of this atrophy to those of diaphragmatic muscle |
| Diaphragmatic strength | intraoperative | Relation between diaphragmatic atrophy and decrease of diaphragmatic strength |
| Early or late extubation failure rate (extubation performed before or after 48 hours) | The last day of hospitalisation | Relation between diaphragmatic atrophy importance and premature (\<48h) or late extubation failure |
| MRC score (Medical Research Council) | intraoperative | Relation between diaphragmatic atrophy and decrease of diaphragmatic strength |
| Length of ventilation in hours | 10 days after start of ventilatory support | — |
| Diaphragm thickness measured by ultrasound | 10 days after introduction of Mechanical Ventilation | — |
| Total positive end expiratory pressure | 10 days after start of ventilatory support | — |
| External positive end expiratory pressure | 10 days after start of ventilatory support | — |
| Respiratory rate | 10 days after start of ventilatory support | — |
| Highest inspiratory pressure level | 10 days after start of ventilatory support | — |
| Highest expiratory pressure level | 10 days after start of ventilatory support | — |
| Volume of exhaled air | 10 days after start of ventilatory support | — |
| Drug administration | 10 days after start of ventilatory support | Presence of drug administration such as curare, corticoid or sedative. If yes : number of days with treatment |
Outcome results
None listed