CODEX: Diaphragmatic Ultrasound Associated With RSBI Predict Weaning Issue: the Rapid Shallow Diaphragmatic Index (RSDI)
Study Details
Study Description
Brief Summary
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.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Ventilated patients 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. |
Diagnostic Test: assess diaphragmatic displacement (DD) using ultrasonography
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.
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Outcome Measures
Primary Outcome Measures
- Difference between the RSBI area and the RSDI AUC [72 hours post-extubation]
Difference between the RSBI area under the receiving operator character curve (AUC) and the RSDI AUC in predicting success of mechanical ventilation weaning.
Secondary Outcome Measures
- Find a cut-off value for RSDI [72 hours post-extubation]
- Find a cut-off value for RSDI with the best predicting accuracy for the weaning
- Compare traditional RSBI values recorded with scientific publications [72 hours post-extubation]
- Find reasons for non-extubation when criteria are gathered [72 hours post-extubation]
- Estimate average duration of mechanical ventilation in central nervous system disorder patient [72 hours post-extubation]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age ≥ 18 years
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Mechanically ventilated patient > 24 hours
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Weaning ventilator phase (PEEP < 9 cmH2O and Support < 15 cm H2O)
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Ventilated via tracheostomy tube patient can be included on removal day of the cannula
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Patient's agreement to participate
Exclusion Criteria:
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Moribund patient
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Decision to forgo life sustaining therapy patient
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Patient with ventilation via tracheostomy tube before admission to ICU
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BMI > 45
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | CHR d'Orléans | Orléans | France | 45067 |
Sponsors and Collaborators
- Centre Hospitalier Régional d'Orléans
Investigators
- Principal Investigator: Guillaume FOSSAT, CHR Orléans
Study Documents (Full-Text)
None provided.More Information
Publications
- Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest. 2009 Feb;135(2):391-400. doi: 10.1378/chest.08-1541. Epub 2008 Nov 18.
- DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014 May;69(5):423-7. doi: 10.1136/thoraxjnl-2013-204111. Epub 2013 Dec 23.
- Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care. 2017 Jan;30(1):37-43. doi: 10.1016/j.aucc.2016.03.004. Epub 2016 Apr 22.
- Forgiarini LA Junior, Esquinas AM. The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data. J Bras Pneumol. 2016 Jul-Aug;42(4):306. doi: 10.1590/S1806-37562016000000099. English, Portuguese.
- Spadaro S, Grasso S, Mauri T, Dalla Corte F, Alvisi V, Ragazzi R, Cricca V, Biondi G, Di Mussi R, Marangoni E, Volta CA. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Crit Care. 2016 Sep 28;20(1):305.
- CHRO-2018-02