Diaphragmatic Dysfunction and Cardiac Surgery; Perioperative Assessment and Effect on Outcome

Study Overview
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Brief Summary
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This study evaluates incidence of diaphragmatic dysfunction after cardiac surgery and its effect on outcome of surgery.

Detailed Description
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Diaphragmatic dysfunction will be assessed by ultrasonography the day before operation and first post operative day, by measuring diaphragmatic thickening during inspiration and expiration.incidence of diaphragmatic dysfunction and its effect on outcome of surgery then will be analysed.

Official Title
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Diaphragmatic Dysfunction and Cardiac Surgery; Perioperative Assessment and Effect on Outcome; Prospective Observational Study

Conditions
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Diaphragm Disease

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years old and older Planned cardiac surgery Ready for weaning from mechanical ventilation (fraction of inspired oxygen (FIO2) ≤ 50%, positive end-expiratory pressure(PEEP) level≤ 5 centimeter water (cmH2O), respiratory rate ≤30 breaths/min, partial pressure of oxygen in arterial blood(PaO2)/FIO2 ratio >200 , Glasgow coma score ≥14). Stable cardiovascular status (i.e., heart rate <120 beats/min; systolic blood pressure, 90-160 mmHg; and no or minimal vasopressor use, i.e., dopamine or dobutamine ≤5 μg/kg/min or noradrenaline ≤0.05 μg/kg/min). Stable metabolic status (i.e., electrolytes and glycaemia within normal range, body temperature <38 °C, hemoglobinemia ≥8-10 g/dL). Exclusion Criteria: Patients with a history of diaphragmatic or neuromuscular disease or evidence of pneumothorax or pneumomediastinum. Patients with low EF (EF ≤ 30%). Patients with post-operative cerebrovascular stroke. Reventilation due to cardiac cause ( arrest, arrhythmias, or failure) Patient refusal.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| diaphragmatic dysfunction<br>diaphragmatic displacement < 10 ml, and / OR diaphragmatic thickening fraction < 36 %. | |
| non diaphragmatic dysfunction<br>diaphragmatic displacement > 10 ml, and / OR diaphragmatic thickening fraction > 36 %. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diaphragmatic excursion. | diaphragmatic excursion (displacement, cm) | at the beginning of the spontaneous breathing trial (around 4hours after surgery). | 
| diaphragmatic dysfunction post cardiac surgery. | diaphragmatic thickening fraction [Thickness at end inspiration - Thickness at end expiration] / Thickness at end expiration | at the beginning of the spontaneous breathing trial (around 4hours after surgery). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| . Diaphragmatic excursion | diaphragmatic excursion (displacement, cm) | the day before surgery | 
| • Diaphragm dysfunction before surgery | diaphragmatic thickening fraction [Thickness at end inspiration - Thickness at end expiration] / Thickness at end expiration | the day before surgery | 
| Left ventricular ejection fraction | as indicator of cardiac function | the day before surgery | 
| • Total ventilation time | in term of hours (in diaphragmatic dysfunction group) | from time of addmission to surgical ICU up to 1 week | 
| • Extracorporeal circulation duration | cardiopulmonary bypass time in term of minutes | peroperative | 
| • Ventilation free days. | after extubation first time tell end of ICU stay, in term of days (in diaphragmatic dysfunction group) | from time of admission to surgical ICU up to 1 week | 
| • Total ICU stay | in term of days (in diaphragmatic dysfunction group) | from time of admission to surgical ICU up to 1 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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diaphragm, ultrasound, dysfunction, cardiac surgery, weaning