Weaning From Mechanical Ventilation Clinical Trial
Official title:
Diaphragmatic Tissue Doppler During Weaning From Mechanical Ventilation
Weaning from mechanical ventilation is a critical issue and the diaphragmatic disfunction has been demonstrated to play an important role in extubation failure. the aim of present investigation is to evaluate diaphragmatic excursion velocity during in patients undergoing spontaneous breathing trial through tissue Doppler analysis in both inspiration and expiration.
Tobin Index (RSBI), which is the ratio between respiratory rate (RR) and tidal volume (VT),
is one of the most used indices to predict weaning outcome. The diaphragm plays a key role in
generating VT and, in the case of diaphragmatic dysfunction, inspiratory accessory muscles
may contribute to support ventilation. If this occurs during a spontaneous breathing trial
(SBT), it will probably result in delayed weaning, since the accessory muscles are more
fatigable than the diaphragm.
The diaphragmatic tissue Doppler imaging (TDI) is an ultrasonographic technique derived from
ultrasound evaluation of heart's motility. Being a muscle doppler assessment, it can be
easily used on the diaphragm to calculate the speed of muscles displacement that could be
associated with patient's respiratory drive, as well as other derived index of muscle
function.
The aim of the study is to measure the variations of diaphragmatic displacement velocities
before and during the spontaneous breathing trial, useful to check if the patient is ready to
breathe spontaneously. An observational study will be performed. Patients who are ready to be
weaned will be subjected to a spontaneous breathing test (Cpap 5), that consists of applying
a positive end-expiratory pressure of 5 cm H2O for 20 minutes. A tissue Doppler evaluation
will then be performed by analyzing the diaphragmatic displacement velocity during
inspiration and expiration in the modality of ventilation which precedes the trial and during
the SBT.
Vital parameters will be monitored during the study. Mechanical ventilation length, incidence
of tracheostomies, ICU and hospital recovery duration and hospital mortality will also be
acquired.
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