Respiratory Failure, Diaphragm Injury, Lung Transplant; Complications, Mechanical, Mechanical Ventilation Complication
Conditions
Brief summary
The study is designed to characterize the changes in diaphragm function after lung transplantation.
Detailed description
Diaphragm dysfunction (DD) is a well-known complication after lung transplantation. Patients with an injured and dysfunctional diaphragm have greater difficulty weaning from mechanical ventilation post-transplant - they become too weak to breathe. However, little is known about the pre-transplant predictive factors associated with diaphragm dysfunction . We have developed a new technique employing beside ultrasound to measure diaphragm thickness. This allows us to observe changes in diaphragm muscle structure and function. The goal of the study is to determine whether pre-transplant diaphragm thickness and function are associated with diaphragmatic dysfunction after lung transplantation. This will help us to confirm the best way to avoid diaphragm injury and to understanding the meaning of diaphragm ultrasound images.
Interventions
DIAGNOSTIC_TESTUltrasound
Sonographic measurements (diaphragm, abdominal muscle, and quadriceps thickness) will be acquired when listed for lung transplantation. Sonographic measurements will be recorded on a daily basis for up to 1 week after transplantation (while the patient remains intubated).
DIAGNOSTIC_TESTRespiratory function measurements
Maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP) will be acquired after listing for lung transplantation. After transplant, MIP will be recorded once patients are eligible for a trial of spontaneous breathing and weekly thereafter. MEP will also be recorded at ICU discharge.
Sponsors
University Health Network, Toronto
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients greater than 18 years of age * Listed for lung transplantation
Exclusion criteria
* Known diagnosis of chronic neuromuscular disease * Relisting for transplantation * Bridging to lung transplantation with respiratory support
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of diaphragm dysfunction at the first spontaneous breathing trial and at ICU discharge after lung transplantation | First spontaneous breathing trial, an average of 1 to 7 days | Diaphragm ultrasound will be used to visualize diaphragm dysfunction (maximal thickening fraction \<20%) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pre-transplant diaphragm thickness and function compared to post-transplant diaphragm dysfunction | 1 day | Diaphragm thickness and function documented on ultrasound will be assessed |
Countries
Canada
Outcome results
None listed