Inspiratory muscle weakness develops rapidly in ventilated critically ill patients and is associated with adverse outcome, including prolonged duration of mechanical ventilation and mortality. Surprisingly, the effects of critical illness on expiratory muscle function have not been studied. The main expiratory muscles are the abdominal wall muscles, including the external oblique (EO), internal oblique (IO) and transversus abdominis muscles (TRA). These muscles are activated when respiratory drive or load increases, which can be during e.g. exercise, diaphragm fatigue, increased airway resistance, or positive airway pressure ventilation. The abdominal wall muscles are also critical for protective reflexes, such as coughing. Reduced abdominal muscles strength may lead to decreased cough function and thus inadequate airway clearance. This will lead to secretion pooling in the lower airways, atelectasis, and ventilator associated pneumonia (VAP). Studies have shown that decreased cough function is a risk for weaning failure and (re)hospitalization for respiratory complications. Further, high mortality was found in patients with low peak expiratory flow. Considering the importance of a proper expiratory muscle function in critically ill patients, it is surprising that the prevalence, causes, and functional impact of changes in expiratory abdominal muscles thickness during mechanical ventilation (MV) for critically ill patients are still unknown. Ultrasound is increasingly used in the ICU for the visualization of respiratory muscles. In a recent pilot study the investigators confirmed the feasibility and reliability of using of ultrasound to evaluate both diaphragm and expiratory abdominal muscle thickness in ventilated critically ill patients (manuscript in preparation). Accordingly, the primary aim of the present study is to evaluate the evolution of abdominal expiratory muscle thickness during MV in adult critically ill patients, using ultrasound data.
Study Type
OBSERVATIONAL
Enrollment
113
Data from ultrasound measurements and from the electronic patient record will be obtained / analyzed. One additional blood sample will be obtained within 24 hours after inclusion, during planned blood collection (from arterial line or venous puncture).
VU University Medical Center
Amsterdam, North Holland, Netherlands
Abdominal expiratory muscle thickness
Thickness of the abdominal expiratory muscles measured in millimeters
Time frame: From the date of inclusion until the date of first extubation or date of death from any cause, whichever came first, assessed up to 6 weeks
Diaphragm muscle thickness
Thickness of the diaphragm muscle measured in millimeters
Time frame: From the date of inclusion until the date of first extubation or date of death from any cause, whichever came first, assessed up to 6 weeks
Inflammatory markers
Inflammatory markers (TNF-alpha, IL-6, IL-10) at inclusion (measured from blood sample using ELISA technique).
Time frame: Within 24 hours after inclusion
Applied driving pressure
Appplied driving pressuye defined as peak pressure minus total postive end expiratory pressure, and measured in centimetre of water
Time frame: From the date of inclusion until the date of first extubation or date of death from any cause, whichever came first, assessed up to 6 weeks
Tidal volume
Tidal volume measured in liters
Time frame: From the date of inclusion until the date of first extubation or date of death from any cause, whichever came first, assessed up to 6 weeks
Positive end expiratory pressure
Postive end expiratory pressure measure in centimetre of water
Time frame: From the date of inclusion until the date of first extubation or date of death from any cause, whichever came first, assessed up to 6 weeks
Extubation failure
Reintubated after extubation
Time frame: From the date of extubation to the date of reintubation, or the date of death from any cause, or the date of ICU discharge, whichever came first, assessed up to 6 weeks
Readmission to ICU
Readmitted to ICU after the ICU discharge
Time frame: From the date of ICU diascharge to the date of death from any cause, or the date of hospital discharge, whichever came first, assessed up to 6 weeks
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.