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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
A diaphragmatic tissue Doppler evaluation will be performed during non-invasive ventilation and spontaneous breathing trial applied in random sequence. Each trial will last 20 minutes. During the last minute of each trial a tissue doppler diaphragmatic examination will be performed to assess the speed of diaphragmatic displacement during inspiration and expiration.
A.O.U Maggiore della Carità
Novara, Italy
RECRUITINGdiaphragmatic displacement velocity
Inspiratory and expiratory diaphragmatic displacement velocity evaluated with tissue doppler during the NIV trial and in spontaneous breathing with Venturi mask.
Time frame: through each trial completion, an average of 20 minutes
Diaphragmatic acceleration
Inspiratory and expiratory diaphragmatic displacement acceleration evaluated with tissue doppler during the NIV trial and in spontaneous breathing with Venturi mask.
Time frame: through each trial completion, an average of 20 minutes
Gas exchange - arterial carbon dioxide tension
PaCO2, will be obtained performing ABG sample
Time frame: through each trial completion, an average of 20 minutes
Gas exchange - pH
pH will be obtained performing ABGs.
Time frame: through each trial completion, an average of 20 minutes
Gas exchange - arterial oxygen tension
arterial oxygenation PaO2 will be obtained performing ABGs.
Time frame: through each trial completion, an average of 20 minutes
Dyspnea level
dyspnea level evaluated through visual analogical scale ( VAS dyspnea)
Time frame: through each trial completion, an average of 20 minutes
Comfort level
Comfort level evaluated through Comfort Scale
Time frame: through each trial completion, an average of 20 minutes
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Hemodynamic parameters, Heart Rate (HR)
Heart Rate (HR)
Time frame: athrough each trial completion, an average of 20 minutes
Blood Pressure (BP)
invasive Mean arterial Blood Pressure
Time frame: through each trial completion, an average of 20 minutes