Diaphragmatic Ultrasound Associated With RSBI Predict Weaning Issue: the Rapid Shallow Diaphragmatic Index (RSDI)

Centre Hospitalier Régional d'Orléans100 enrolled

Overview

The Rapid Shallow Breathing Index (RSBI) is the ratio between respiratory rate (RR) and tidal volume (VT). It is routinely used to predict mechanical ventilation weaning outcome in ICU patients. However RSBI doesn't reflect the muscular contribution of diaphragm or accessory muscles in generating tidal volume. Actually, diaphragmatic dysfunction can even delay weaning process, because accessory muscles are more fatigable than the diaphragm. Hence, the investigators hypothesized that diaphragmatic displacement (DD) could be associated with RSBI in a new index named Rapid Shallow Diaphragmatic Index (RSDI) such as: RSDI = RSBI/DD. The aim of this study is to compare the ability of the RSDI versus the traditional RSBI to predict weaning success in ready-to-wean patients.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

100

Conditions

Mechanical Ventilation Mechanical Ventilator Weaning Extubation Diaphragm Ultrasound

Interventions

assess diaphragmatic displacement (DD) using ultrasonographyDIAGNOSTIC_TEST

During a spontaneous breathing trial (SBT) we will simultaneously, for all included patient, assess diaphragmatic displacement (DD) using ultrasonography, respiratory rate (RR) and tidal volume (VT) on ventilator screen.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥ 18 years * Mechanically ventilated patient \> 24 hours * Weaning ventilator phase (PEEP \< 9 cmH2O and Support \< 15 cm H2O) * Ventilated via tracheostomy tube patient can be included on removal day of the cannula * Patient's agreement to participate Exclusion Criteria: * Moribund patient * Decision to forgo life sustaining therapy patient * Patient with ventilation via tracheostomy tube before admission to ICU * BMI \> 45

Outcomes

Primary Outcomes

Difference between the RSBI area and the RSDI AUC

Difference between the RSBI area under the receiving operator character curve (AUC) and the RSDI AUC in predicting success of mechanical ventilation weaning.