Acute Respiratory Failure Clinical Trial
Official title:
Diaphragm Performance Evaluation With Tissue Doppler Ultrasound Examination During Spontaneous Breathing in Facial Mask and During Non-invasive Ventilation in the Post-extubation Period.
The aim of the present investigation will be to evaluate diaphragmatic excursion velocity
during non-invasive ventilation and spontaneous breathing at both inspiration and expiration.
this analysis will be performed through diaphragmatic tissue Doppler assessment.
Early weaning from invasive ventilation, in patients admitted to intensive care, is
associated with a marked reduction in ventilator-associated pneumonia, length of stay in
intensive care unit and hospital, total duration of mechanical ventilation and decrease in
overall mortality. Moreover, in case of need of protected extubation, non-invasive
ventilation has allowed to prevent re-intubation and decrease hospital mortality compared to
the simple administration of oxygen through a facial mask, in particular when applied
immediately after extubation.
The diaphragmatic tissue doppler imaging (TDI) is an ultrasonographic technique derived from
ultrasound evaluation of the heart's motility. It can be easily used on the diaphragm to
calculate the speed of muscles displacement that could be associated with patient's
respiratory drive.
The aim of the study is the evaluation of the diaphragmatic excursion velocity variations
using diaphragmatic tissue doppler, measured in venturi mask and non-invasive ventilation in
the post-extubation period, in order to compare the diaphragm stress variations during the
two different modes.
Method Patients after extubation will be randomly submitted to a spontaneous breathing test
in venturi mask and in facemask or helmet NIV.
Each trial will last 20 minutes. During the last minute of each trial a tissue doppler
diaphragm examination will be performed to assess the speed speed of muscle displacement,
acceleration and deceleration.
Inclusion criteria: invasive mechanical ventilation > 24h with consequent extubation.
Exclusion criteria: refusal to grant consent, pregnancy, age < 18 years, haemodynamic
instability, difficult management of secretions, required inotropic and / or vasoactive drugs
at high doses.
During the study, vital parameters will be given.
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