Diaphragmatic Ultrasound in Weaning
Conditions
Brief summary
To assess value of adding ultrasound derived variables to the usual parameters on success rate of weaning from mechanical ventilation in critically ill patients and to validate sensitivity and specificity of ultrasound derived variables (thickening fraction /diaphragmatic excursion)
Detailed description
Difficult weaning from mechanical ventilation (MV) is a common problem in critically ill patients. Many parameters have been developed to aid weaning from MV such as P/F ratio (PO2/FiO2) and rapid shallow breathing index (respiratory rate/tidal volume), however, sensitivity and specificity for most variables are still variable in literature. Multiple studies have found that patients tolerantof SBTs were found to have successful discontinuationsat least 77% of the time. Causes of weaning failure include: airway and lung dysfunction, brain dysfunction, cardiac dysfunction, diaphragm dysfunction, and endocrine dysfunction . Diaphragmatic dysfunction is a common cause of weaning failure , however most of the traditional methods used for evaluation of diaphragmatic function (fluoroscopy, trans-diaphragmatic pressure measurement) are invasive and not available. Ultrasound assessment of diaphragmatic function has been developed recently providing an easy and safe method for evaluation of diaphragmatic excursion and thickening. It was found that weaning failure (Re-intubation within 48 hours) was associated with diaphragmatic excursion \<1 cm and thickening fraction \<28% several studies reported the value of diaphragmatic ultrasound to predict weaning failure ,however no one of them used diaphragmatic ultrasound to guide weaning. previous studies showed that failure rate of weaning from mechanical ventilation was 27% ,however failure rate in our department was 43% adding ultrasound derived values aims for improving success rate of weaning from mechanical ventilation.
Interventions
DEVICEdiaphragmatic ultrasound
Diaphragmatic excursion; Diaphragmatic movement will be measured with a 3.5-MHz US probe (Mindray machine, DC-N6).
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Critically ill patients intubated for more than 48 hours who are ready for weaning
Exclusion criteria
* • Age \< 18 years * surgical dressings over the right lower rib cage which would preclude ultrasound examination * patients with chest trauma, thoracotomy, diaphragmatic paralysis, diaphragmatic injury and diaphragmatic surgery * patients with neuromuscular diseases ( myasthenia gravis ,Muscular dystrophies ,Multiple sclerosis and Amyotrophic lateral sclerosis)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Success rate of weaning from mechanical ventilation in both groups | 48 Hours after weaning | (The trial will be considered a successful weaning trial if the patient passed 48 hours without the need for neither invasive nor non-invasive ventilation) |
Secondary
| Measure | Time frame |
|---|---|
| • Days of ventilation (before weaning trial) in correlation to diaphragmatic dysfunction | baseline |
| • Number of weaning trials prior to inclusion in the study | baseline |
| • Rapid shallow breathing index (RSBI) and its correlation with ultrasound derived variables | baseline |
Countries
Egypt
Outcome results
None listed