The Role of Diaphragmatic Ultrasound as a Predictor of Extubation From Mechanical Ventilation

Study Overview
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Brief Summary
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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
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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

Official Title
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The Role of Diaphragmatic Ultrasound as a Predictor of Successful Extubation From Mechanical Ventilation in Respiratory Intensive Care Unit

Conditions
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Diaphragm Ultrasound

Intervention / Treatment
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* Device: ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Critically ill patients intubated for more than 48 hours who are ready for weaning with the following criteria. positive end-expiratory pressure (PEEP) ≤ 5 cm H2O. Fraction of inspired oxygen (FiO2) < 0.5. respiratory rate (RR) < 30 breaths/min. 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 .

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group B<br>40 patients who are mechanically ventilated due to pulmonary disease at respiratory ICU had their diagnosis as follows: 21 (53%) had COPD, 8 (20%) had asthma, 5 (13%) had bronchiectasis, 5 (13%) had pneumonia and 1 (3%) had viral influenza H1N1. Out of group B patients, 11 patients (13.75%) had failed weaning, of which 6 patients needed reintubation and 5 patients needed non-invasive positive ventilation of which 3 patients were re-intubated and 2 patients died. | Device: ultrasound<br>* ultrasound on diaphragm<br>|
| Group A<br>40 patients on mechanical ventilation due to non-pulmonary disease at respiratory ICU had their diagnosis as follows: 24 (60%) had congestive heart failure, 4 (10%) had diabetes mellitus, 4 (10%) had sepsis other than pneumonia, 2 (5%) had epilepsy, 2 (5%) had embolic hemiplegia, and 4 (10%) had chronic renal failure. Out of group A patient, 9 patients (11.25%) had failed weaning of which 4 patients needed reintubation and 5 patients needed non-invasive positive ventilation of which 2 patients were reintubated and 3 patients died. | Device: ultrasound<br>* ultrasound on diaphragm<br>|
| control group.<br>40 patients Chronic obstructive pulmonary disease (COPD) from Outpatient Clinic | Device: ultrasound<br>* ultrasound on diaphragm<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| diaphragmatic ultrasound thickening | 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 | during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year | 
| diaphragmatic ultrasound thickening fraction | 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 | during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year | 
| diaphragmatic ultrasound excursion | 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 | during weaning from mechanical ventilation 0n T- tube, through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| diaphragmatic ultrasound thickening fraction | Differences in thickening fraction ( millimeter )between patients who are successfully and failed weaning . | Up to 48 hours on T-tube, through study completion, an average of 1 year | 
| diaphragmatic ultrasound thickening | Differences in diaphragm thickening(percentage% )between patients who are successfully and failed weaning . | Up to 48 hours on T-tube, through study completion, an average of 1 year | 
| diaphragmatic ultrasound excursion | Differences in diaphragm excursion ( centimeter) between patients who are successfully and failed weaning | Up to 48 hours on T-tube, through study completion, an average of 1 year |