Diaphragm Ultrasound
Conditions
Brief summary
Aim: To evaluate real-time ultrasound in the evaluation of diaphragmatic thickening, thickening fraction and or excursion to predict extubation outcomes. The investigators aimed to compare these parameters with other traditional weaning measures.
Detailed description
The diaphragm is an important respiratory muscle and dysfunction is very common in patients receiving mechanical ventilation. Diaphragm fatigue occurs even in patients who successfully pass the Spontaneous Breathing Test (SBT). Interrupting ventilation too early can lead to increased cardiovascular and respiratory pressure (CO2).retention and hypoxemia with up to 25% of patients requiring reinstitution of ventilator support. Unnecessary delays in liberation from mechanical ventilation also can be deleterious. Complications such as ventilator-associated pneumonia and ventilator-induced diaphragm atrophy can be seen with short periods of mechanical ventilation thereby prolonging mechanical ventilation. As SBT monitoring is insensitive to detect early signs of load-capacity imbalance. The evaluation of the diaphragmatic thickening fraction (DTF) may be also helpful to assess diaphragmatic function and its contribution to respiratory workload. Ultrasound can be used to detect the deflection of the diaphragm, which helps to identify patients with diaphragm dysfunction
Interventions
DEVICEultrasound
ultrasound on diaphragm
Sponsors
Beni-Suef University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Inclusion criteria
* Critically ill patients intubated for more than 48 hours who are ready for weaning with the following criteria. 1. positive end-expiratory pressure (PEEP) ≤ 5 cm H2O. 2. Fraction of inspired oxygen (FiO2) \< 0.5. 3. respiratory rate (RR) \< 30 breaths/min. 4. rapid shallow breathing index \< 105, PaO2/FiO2 \> 200. * Age\< 65 years.
Exclusion criteria
* Age\<18 years. * Patient with history of plural effusion, trauma to chest and history of mechanical ventilation for \< 6 months. * patient with neuromuscular diseases affect diaphragm .
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| diaphragmatic ultrasound thickening | during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year | Right diaphragmatic ultrasound measurement thickening in millimeter was made during tidal and deep breathing . patient is in the supine position and measurement of right diaphragm by M-mode and B-mode images |
| diaphragmatic ultrasound thickening fraction | during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year | Right diaphragmatic ultrasound measurement thickening fraction(percentage% ) was made during tidal and deep breathing . patient is in the supine position and measurement of right diaphragm by M-mode and B-mode images |
| diaphragmatic ultrasound excursion | during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year | Right diaphragmatic ultrasound measurement excursion( centimeter) was made during tidal and deep breathing . patient is in the supine position and measurement of right diaphragm by M-mode and B-mode images |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| diaphragmatic ultrasound thickening fraction | Up to 48 hours on T-tube, through study completion, an average of 1 year | Differences in thickening fraction ( millimeter )between patients who are successfully and failed weaning . |
| diaphragmatic ultrasound thickening | Up to 48 hours on T-tube, through study completion, an average of 1 year | Differences in diaphragm thickening(percentage% )between patients who are successfully and failed weaning . |
| diaphragmatic ultrasound excursion | Up to 48 hours on T-tube, through study completion, an average of 1 year | Differences in diaphragm excursion ( centimeter) between patients who are successfully and failed weaning |
Countries
Egypt
Outcome results
None listed