Acute Respiratory Failure, Non-invasive Ventilation
Conditions
Keywords
Diaphragmatic Tissue Doppler, Non invasive ventilation, Spontaneous breathing, Post-extubation
Brief summary
The aim of the present investigation will be to evaluate diaphragmatic excursion velocity during non-invasive ventilation and spontaneous breathing at both inspiration and expiration. this analysis will be performed through diaphragmatic tissue Doppler assessment.
Detailed description
Early weaning from invasive ventilation, in patients admitted to intensive care, is associated with a marked reduction in ventilator-associated pneumonia, length of stay in intensive care unit and hospital, total duration of mechanical ventilation and decrease in overall mortality. Moreover, in case of need of protected extubation, non-invasive ventilation has allowed to prevent re-intubation and decrease hospital mortality compared to the simple administration of oxygen through a facial mask, in particular when applied immediately after extubation. The diaphragmatic tissue doppler imaging (TDI) is an ultrasonographic technique derived from ultrasound evaluation of the heart's motility. It can be easily used on the diaphragm to calculate the speed of muscles displacement that could be associated with patient's respiratory drive. The aim of the study is the evaluation of the diaphragmatic excursion velocity variations using diaphragmatic tissue doppler, measured in venturi mask and non-invasive ventilation in the post-extubation period, in order to compare the diaphragm stress variations during the two different modes. Method Patients after extubation will be randomly submitted to a spontaneous breathing test in venturi mask and in facemask or helmet NIV. Each trial will last 20 minutes. During the last minute of each trial a tissue doppler diaphragm examination will be performed to assess the speed speed of muscle displacement, acceleration and deceleration. Inclusion criteria: invasive mechanical ventilation \> 24h with consequent extubation. Exclusion criteria: refusal to grant consent, pregnancy, age \< 18 years, haemodynamic instability, difficult management of secretions, required inotropic and / or vasoactive drugs at high doses. During the study, vital parameters will be given.
Interventions
OTHERPost-extubation TDI
A diaphragmatic tissue Doppler evaluation will be performed during non-invasive ventilation and spontaneous breathing trial applied in random sequence. Each trial will last 20 minutes. During the last minute of each trial a tissue doppler diaphragmatic examination will be performed to assess the speed of diaphragmatic displacement during inspiration and expiration.
Sponsors
Azienda Ospedaliero Universitaria Maggiore della Carita
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Single Group Assignment
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* invasive mechanical ventilation \> 24h with consequent extubation
Exclusion criteria
* refusal to grant consent * pregnancy * age \>18 years * haemodynamic instability * difficult management of secretions * required inotropic and / or vasoactive drugs at high doses
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| diaphragmatic displacement velocity | through each trial completion, an average of 20 minutes | Inspiratory and expiratory diaphragmatic displacement velocity evaluated with tissue doppler during the NIV trial and in spontaneous breathing with Venturi mask. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Gas exchange - arterial carbon dioxide tension | through each trial completion, an average of 20 minutes | PaCO2, will be obtained performing ABG sample |
| Gas exchange - pH | through each trial completion, an average of 20 minutes | pH will be obtained performing ABGs. |
| Gas exchange - arterial oxygen tension | through each trial completion, an average of 20 minutes | arterial oxygenation PaO2 will be obtained performing ABGs. |
| Diaphragmatic acceleration | through each trial completion, an average of 20 minutes | Inspiratory and expiratory diaphragmatic displacement acceleration evaluated with tissue doppler during the NIV trial and in spontaneous breathing with Venturi mask. |
| Comfort level | through each trial completion, an average of 20 minutes | Comfort level evaluated through Comfort Scale |
| Hemodynamic parameters, Heart Rate (HR) | athrough each trial completion, an average of 20 minutes | Heart Rate (HR) |
| Blood Pressure (BP) | through each trial completion, an average of 20 minutes | invasive Mean arterial Blood Pressure |
| Dyspnea level | through each trial completion, an average of 20 minutes | dyspnea level evaluated through visual analogical scale ( VAS dyspnea) |
Countries
Italy
Contacts
Primary ContactGianmaria Cammarota, MD,PHD
Backup ContactGianmaria MD Cammarota
Outcome results
None listed