Diaphragm Issues, Intensive Care (ICU) Myopathy, Mechanical Ventilation Complication, Respiratory Failure
Conditions
Brief summary
The gold standard of twitch transdiaphragmatic pressure recordings would ultimately clear the fog around the rate of development of Ventilator induced Diaphragm Dysfunction (VIDD) in mechanically ventilated patients over time. Through measurements made even after mechanical ventilation (MV) it could be clarified to what extent patients recover from VIDD. Paired with cortical stimulation and electromyographic recordings of diaphragm muscle potentials, it could be explored to what extent decreased diaphragm excitability due to long term MV contributes to VIDD on the level of motor cortex. Against that background the present project aims at determining the rate of decline in diaphragm function, strength and control in patients undergoing MV (including measurements after extubation).
Detailed description
Evidence both from animal and human studies support the development of ventilator induced diaphragm dysfunction (VIDD) from as early as 24 hours of mechanical ventilation (MV) in the intensive care unit (ICU). However, while the concept of VIDD seems to be proven now, several questions remain unanswered regarding its actual rate of development and (potentially) recovery after MV. The gold standard of twitch transdiaphragmatic pressure recordings would ultimately clear the fog around the rate of development of VIDD over time. Through measurements made even after MV it could be clarified to what extent patients recover from VIDD. Paired with cortical stimulation and electromyographic recordings of diaphragm muscle potentials, it could be explored to what extent decreased diaphragm excitability due to long term MV contributes to VIDD on the level of motor cortex. Against that background the present project aims at determining the rate of decline in diaphragm function, strength and control in patients undergoing MV (including measurements after extubation).
Interventions
DIAGNOSTIC_TESTRespiratory Muscle Testing
Comprehensive assessment of respiratory muscle function. Comprehensive assessment of respiratory muscle function to the point of its invasive assessment with recordings of twitch transdiaphragmatic pressure in response to magnetic phrenic nerve stimulation and stimulation of the lower thoracic nerve roots.
Sponsors
RWTH Aachen University
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Initiation of invasive mechanical ventilation in the Intensive Care Unit within 48 hours. * Expected duration of invasive mechanical ventilation of at least 5 days. * OR: elective bypass surgery with "planned" invasive mechanical ventilation
Exclusion criteria
* Body-mass-index (BMI) \>40 * Expected absence of active participation of the patient in study-related measurements after extubation * Alcohol or drug abuse * Non MRI compatible implant in the body * Slipped disc * Epilepsy * Patients in an interdependence or with an employment contract with the principal investigator, Co-PI or his deputy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Twitch transdiaphragmatic pressure in response to supramaximal magnetic stimulation of the phrenic nerve roots. | 2 years | — |
| Cortical control of diaphragm function | 2 years | Amplitude of the diaphragm motor evoked potentials (measured by surface electrodes attached to the diaphragm) following cortical magnetic stimulation of the phrenic nerve roots. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diaphragm ultrasound | 2 years | Diaphragm thickening fraction on ultrasound |
| Systemic inflammation | 2 years | Concentration of circulating Interleukin, high-sensitivity C-reactive protein (analyzed quantitatively based on a Levels venous blood sample). |
Countries
Germany
Contacts
CONTACTMichael Dreher, Professor
CONTACTJens Spiesshoefer, MD
STUDY_CHAIRMichael Dreher, Professor
Department of Pneumology and Intensive Care Medicine, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
PRINCIPAL_INVESTIGATORJens Spiesshoefer, MD
Department of Pneumology and Intensive Care Medicine, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
STUDY_DIRECTORThomas Breuer, Professor
Department of Intensive Care Medicine, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
Outcome results
None listed