Mechanical Ventilation
Conditions
Brief summary
Muscle weakness and dysfunction are common problems in patients hospitalized in the intensive care unit. Respiratory muscle weakness during mechanical ventilation was recognized a state of muscular fatigue. The terminology 'ventilator-induced diaphragmatic dysfunction' (VIDD) originally was introduced to describe these effects of mechanical ventilation and respiratory muscle unloading on the diaphragm. Ultrasonography is becoming increasingly popular management of ICU patients. It is a simple, non-invasive and safe imaging technique that can be used for the assessment of distinctive diaphragmatic characteristics. Parameters such as amplitude and velocity of contraction, which can be assessed using M-mode ultrasound. In addition, static and dynamic (thickening fraction during inspiration) diaphragmatic thickness can also be measured by ultrasonography.
Detailed description
The aim of this study is to evaluate the effect of different modes of mechanical ventilation on diaphragmatic thickness using ultrasonography and the relation between time of mechanical ventilation and the percentage of change of diaphragmatic thickness in head trauma patients subjected for mechanical ventilation (\>2 days) intensive care unit. Modes of ventilation will be used in the study are: * Pressure controlled mandatory ventilation mode (P-CMV). * Pressure synchronized intermittent mandatory ventilation mode (P-SIMV). * Pressure support (PS) mode.
Interventions
OTHERPressure controlled mandatory ventilation mode (P-CMV)
Pressure controlled mandatory ventilation mode (P-CMV)
OTHERPressure synchronized intermittent mandatory ventilation
Pressure synchronized intermittent mandatory ventilation
OTHERPressure support mode (PS)
Pressure support mode (PS)
Sponsors
Mansoura University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
MALE
Age
20 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) physical status grades I and II. * Glasgow coma scale \< 8. * Selections of patients need mechanical ventilation (\>2 days). * Head trauma patients.
Exclusion criteria
* History of diaphragmatic disease * Neuromuscular disease * Anatomical malformation of the diaphragm. * Patients with chest disease * Diabetic patients. * Chest trauma * Chest malignancy. * Use of non-invasive ventilation before the start of invasive ventilation. * Selection of patients of short period of mechanical ventilation (\< 2 days). * Hemodynamic instability. * Morbid obesity (body mass index \> 40 kg/m2).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diaphragmatic thickness | for 3 weeks after initiation of mechanical ventilation | changes in diaphragmatic thickness from baseline to nadir |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| respiratory rate | for 3 weeks after initiation of mechanical ventilation | — |
| airway pressure | for 3 weeks after initiation of mechanical ventilation | peak and mean airway pressure |
| Arterial Oxygen Saturation | for 3 weeks after admission to the ICU | — |
| Central Venous Pressure | for 3 weeks after admission to the ICU | — |
| temperature | for 3 weeks after admission to the ICU | — |
| mode of ventilation | for 3 weeks after initiation of mechanical ventilation | — |
| The relation between time of mechanical ventilation and the percentage of change of diaphragmatic thickness | for 3 weeks after initiation of mechanical ventilation | measurement of the diaphragmatic thickness as usual and calculate the percentage of change of the diaphragmatic thickness over the time of mechanical ventilation |
| Glasgow coma scale (GCS) | for 2 weeks after initiation of mechanical ventilation. | — |
| tidal volume | for 3 weeks after initiation of mechanical ventilation | — |
| Complete blood picture | for 3 weeks after admission to the ICU | — |
| Coagulation profile | for 3 weeks after admission to the ICU | — |
| Liver function | for 3 weeks after admission to the ICU | — |
| Renal function tests | for 3 weeks after admission to the ICU | — |
| Mean blood pressure | for 3 weeks after admission to the ICU | — |
| Heart rate | for 3 weeks after admission to the ICU | — |
| ICU stay | for 3 weeks after initiation of mechanical ventilation | Time from admission to the ICU untill discharge or death |
| Duration of mechanical ventilation | for 3 weeks after initiation of mechanical ventilation | time from initiation of mechanical ventilation till extubation or death |
| Sequential organ failure assessment (SOFA) score | for 3 weeks after admission to the ICU | — |
Countries
Egypt
Outcome results
None listed