Diaphragm Ultrasound, Extubation, Mechanical Ventilation, Mechanical Ventilator Weaning
Conditions
Keywords
diaphragm ultrasound, spontaneous breathing trial, mechanical ventilation weaning, rapid shallow breathing index
Brief summary
The Rapid Shallow Breathing Index (RSBI) is the ratio between respiratory rate (RR) and tidal volume (VT). It is routinely used to predict mechanical ventilation weaning outcome in ICU patients. However RSBI doesn't reflect the muscular contribution of diaphragm or accessory muscles in generating tidal volume. Actually, diaphragmatic dysfunction can even delay weaning process, because accessory muscles are more fatigable than the diaphragm. Hence, the investigators hypothesized that diaphragmatic displacement (DD) could be associated with RSBI in a new index named Rapid Shallow Diaphragmatic Index (RSDI) such as: RSDI = RSBI/DD. The aim of this study is to compare the ability of the RSDI versus the traditional RSBI to predict weaning success in ready-to-wean patients.
Interventions
DIAGNOSTIC_TESTassess diaphragmatic displacement (DD) using ultrasonography
During a spontaneous breathing trial (SBT) we will simultaneously, for all included patient, assess diaphragmatic displacement (DD) using ultrasonography, respiratory rate (RR) and tidal volume (VT) on ventilator screen.
Sponsors
Centre Hospitalier Régional d'Orléans
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
* Age ≥ 18 years * Mechanically ventilated patient \> 24 hours * Weaning ventilator phase (PEEP \< 9 cmH2O and Support \< 15 cm H2O) * Ventilated via tracheostomy tube patient can be included on removal day of the cannula * Patient's agreement to participate
Exclusion criteria
* Moribund patient * Decision to forgo life sustaining therapy patient * Patient with ventilation via tracheostomy tube before admission to ICU * BMI \> 45
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference between the RSBI area and the RSDI AUC | 72 hours post-extubation | Difference between the RSBI area under the receiving operator character curve (AUC) and the RSDI AUC in predicting success of mechanical ventilation weaning. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Find a cut-off value for RSDI | 72 hours post-extubation | \- Find a cut-off value for RSDI with the best predicting accuracy for the weaning |
| Compare traditional RSBI values recorded with scientific publications | 72 hours post-extubation | — |
| Find reasons for non-extubation when criteria are gathered | 72 hours post-extubation | — |
| Estimate average duration of mechanical ventilation in central nervous system disorder patient | 72 hours post-extubation | — |
Countries
France
Outcome results
None listed