Post-neurosurgical Respiratory Muscle Dysfunction

Study Overview
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Brief Summary
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Respiratory muscle dysfunction may contribute to the development of postoperative pulmonary complications. However, it prevalence in patients receiving neurosurgery is largely unknown. Therefore, in present study, respiratory muscle function (measured by the ultrasound) and their correlation with the post-operative pulmonary complications will be analyzed.

Detailed Description
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Postoperative pulmonary complications is common in patients receiving neurosurgery, and is associated with hospitalization cost and mortality. Respiratory muscle dysfunction is an important cause postoperative pulmonary complications, however, it's prevalence in patients receiving neurosurgery is unclear. The diaphragm and abdominal expiratory muscles are the main inspiratory and expiratory driving muscles. Ultrasound can assess the function and morphology of these muscles invasively and in realtime. Studies has demonstrated their feasibility and repeatability in realtime monitoring of respiratory muscles. In this study, our primary aim is to assess the respiratory muscle function after neurosurgery, and the correlation between diaphragm and expiratory muscle function. Our secondary aims including the correlation between the brain injury and the respiratory muscle function, and the impact of post-operative respiratory muscle dysfunction on the pulmonary complications.

Official Title
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The Development of Post-operative Respiratory Muscle Dysfunction in Neurosurgical Patients

Conditions
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Diaphragm Issues, Neurosurgery, Pulmonary Complication

Intervention / Treatment
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* Diagnostic Test: Maximum inspiratory/Expiratory manoeuvre for patients can follow the order


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Informed consent First elective operation during hospitalization ASA<3 Exclusion Criteria: Brain stem and spinal spine lesions Preoperative chest imaging findings were abnormal Mechanical ventilation was required before surgery Clinical or radiological evidence of preoperative misaspiration History of neurosurgery in the last 6 months A history of neuromuscular disease BMI≥35kg/m2 Pregnant women Skin lesions detected by ultrasound

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 |
| --- | --- |
| Patients with diaphragm weakness<br>Diaphragm weakness will be defined as thickening fraction <=20 % at the time of extubation | Diagnostic Test: Maximum inspiratory/Expiratory manoeuvre for patients can follow the order<br>* Bedside ultrasound will be performed for each patient at the time before, after surgery, before and after extubation, and at the time of ICU discharge, under the end-expiratory occlusion, maximum inspiratory, and/or expiratory manoeuvre<br>* Other names: End-expiratory occlusion in patients with endotracheal tube in situ;|
| Patients without diaphragm weakness<br>Diaphragm thickening fraction >20 % at the time of extubation | Diagnostic Test: Maximum inspiratory/Expiratory manoeuvre for patients can follow the order<br>* Bedside ultrasound will be performed for each patient at the time before, after surgery, before and after extubation, and at the time of ICU discharge, under the end-expiratory occlusion, maximum inspiratory, and/or expiratory manoeuvre<br>* Other names: End-expiratory occlusion in patients with endotracheal tube in situ;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of diaphragm dysfunction after neurosurgery | The diaphragm dysfunction is defined as the thickening fraction < 20% under the maximum inspiration | Within 24 hours after the completion of surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The correlation between the level of NSE and the diaphragm function | The level of NSE is measured in the blood sample within 24 hours after surgery | Within 24 hours after the completion of surgery | 
| The correlation between the level of inflammation maker ILs and the diaphragm function | The level of ILs are measured in the blood sample within 24 hours after surgery | Within 24 hours after the completion of surgery | 
| The correlation between the level of inflammation maker TNF-alpha and the diaphragm function | The level of TNF-alpha is measured in the blood sample within 24 hours after surgery | Within 24 hours after the completion of surgery | 
| The thickening fraction of expiratory muscles after surgery | the thickening fraction of expiratory muscle is measured under the maximum expiration maneuver | Within 24 hours after the completion of surgery | 
| The incidence of postoperative pulmonary complication | The postoperative pulmonary complication is defined as when patient has developed one or more complications including pneumonia, atelectasis, pulmonary edema, pulmonary embolism, or respiratory failure | Through study completion, an average of 1 month | 
| The length of hospital stay | The length of hospital stay is counted by day | Through study completion, an average of 1 month | 
| The length of ICU stay | The length of ICU stay is counted by day | Through study completion, an average of 1 month | 
| Duration of mechanical ventilation | The duration of mechanical ventilation is counted by hours | Through study completion, an average of 1 month | 
| Hospital mortality | The hospital mortality is recorded at the time of discharge | Through study completion, an average of 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neurosurgery, Respiratory muscle dysfunction, Diaphragm, Expiratory muscle, Post operative pulmonary complications