Mechanical Ventilation Weaning
Conditions
Keywords
diaphragmatic dysfunction, mechanical ventilation weaning, failure extubation rate
Brief summary
Extubation is a crucial step when patients are being weaned from mechanical ventilator support. Indeed, the patient has to face an increasing burden imposed to the ventilation system. The ability to overcome this event will determine the patient survival. A warning signal could be very useful is this situation. 2 recent studies have shown that measuring diaphragmatic cupolas and muscular fibers thickening fraction could help to spot a population with a high risk of diaphragmatic weakness, characterized by a high failure extubation rate. This study aims to verify that this kind of group of patients does exist.
Interventions
PROCEDUREDiaphragmatic ultrasound
All patients will have a diaphragmatic ultrasound in the 4 hours before the extubation. * a record of the right and left diaphragmatic cupolas run, with a chest approach and using a 4-5 MHz (megahertz) cardiac or abdominal sensor. 3 acquisitions for each side * a record of the diaphragm thickening at the right and left apposition zones with a 10-12 MHz (megahertz) vascular sensor. 3 acquisitions for each side
Sponsors
Poitiers University Hospital
Centre Hospitalier Saint Joseph Saint Luc de Lyon
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Successful spontaneous breathing trial and extubation expected on the same day and 1 of the following criteria : * Age \> 65 * Mechanical ventilation during \> 7 days * Cardiac history (ischemic, rhythmic or valve cardiopathy) * Respiratory history (documented or likely chronic respiratory failure)
Exclusion criteria
* Patient who is tracheotomized * Peripheric neuromuscular disease (myasthenia, myopathy) * Surgery circumstances that could affect the quality of the ultrasound exam (drains or bandages) * Pregnant woman * Age \< 18
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Extubation success rate | 7 days after the reported extubation | Extubation success rate, defined as no reintubation 7 days after the reporting extubation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of mechanical ventilation | At the extubation time | — |
| Number of patients with invasive or non-invasive mechanical ventilation | 48 hours after the extubation | Resort to invasive or non-invasive mechanical ventilation |
| Mortality | At discharge of reanimation unit (up to 1 year) | — |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a clinical parameter : cough strength measured with a defined scale | At the extubation time | The scale used to measure the cough is the following : * absent * inefficient * low efficiency * mild efficiency * efficient |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a clinical parameter : quantity of secretions measured with a defined scale | At the extubation time | * any secretions * low secretions * mild secretions * abundant secretions * very abundant secretions |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a clinical parameter : presence/absence or cervical tonus | At the extubation time | — |
| Length of stay in reanimation unit (days) | At discharge of reanimation unit (up to 1 year) | — |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : maximal inspiratory pressure in centimeters of water | At the extubation time | — |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : minimal expiratory pressure measured in centimeters of water | At the extubation time | — |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : peak flow measured in L/min (liters per minute) | At the extubation time | — |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : peak flow when coughing measured in L/min (liters per minute) | At the extubation time | — |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : P0,1 measured in milliseconds | At the extubation time | — |
| Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a clinical parameter : F/Vt ratio measured in breaths/min/L | At the extubation time | — |
Countries
France
Outcome results
None listed