Extubation is a crucial step when patients are being weaned from mechanical ventilator support. Indeed, the patient has to face an increasing burden imposed to the ventilation system. The ability to overcome this event will determine the patient survival. A warning signal could be very useful is this situation. 2 recent studies have shown that measuring diaphragmatic cupolas and muscular fibers thickening fraction could help to spot a population with a high risk of "diaphragmatic weakness", characterized by a high failure extubation rate. This study aims to verify that this kind of group of patients does exist.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
74
All patients will have a diaphragmatic ultrasound in the 4 hours before the extubation. * a record of the right and left diaphragmatic cupolas run, with a chest approach and using a 4-5 MHz (megahertz) cardiac or abdominal sensor. 3 acquisitions for each side * a record of the diaphragm thickening at the right and left apposition zones with a 10-12 MHz (megahertz) vascular sensor. 3 acquisitions for each side
Centre Hospitalier Saint Joseph Saint Luc
Lyon, France
Centre Hospitalier Annecy Genevois
Metz-Tessy, France
Centre Hospitalier Universitaire de Poitiers
Poitiers, France
Extubation success rate
Extubation success rate, defined as no reintubation 7 days after the reporting extubation
Time frame: 7 days after the reported extubation
Length of stay in reanimation unit (days)
Time frame: At discharge of reanimation unit (up to 1 year)
Length of mechanical ventilation
Time frame: At the extubation time
Number of patients with invasive or non-invasive mechanical ventilation
Resort to invasive or non-invasive mechanical ventilation
Time frame: 48 hours after the extubation
Mortality
Time frame: At discharge of reanimation unit (up to 1 year)
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a clinical parameter : cough strength measured with a defined scale
The scale used to measure the cough is the following : * absent * inefficient * low efficiency * mild efficiency * efficient
Time frame: At the extubation time
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a clinical parameter : quantity of secretions measured with a defined scale
* any secretions * low secretions * mild secretions * abundant secretions * very abundant secretions
Time frame: At the extubation time
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a clinical parameter : presence/absence or cervical tonus
Time frame: At the extubation time
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a clinical parameter : F/Vt ratio measured in breaths/min/L
Time frame: At the extubation time
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : maximal inspiratory pressure in centimeters of water
Time frame: At the extubation time
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : minimal expiratory pressure measured in centimeters of water
Time frame: At the extubation time
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : peak flow measured in L/min (liters per minute)
Time frame: At the extubation time
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : peak flow when coughing measured in L/min (liters per minute)
Time frame: At the extubation time
Comparison between the predictive value of diaphragmatic ultrasound dysfunction and a paraclinical parameter : P0,1 measured in milliseconds
Time frame: At the extubation time
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