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NCT07405567
Patients with pneumonia who require invasive mechanical ventilation in the intensive care unit (ICU) often experience difficulties during the process of being separated from the breathing machine (weaning). Failure of weaning is associated with longer ventilation duration, prolonged ICU stay, and increased risk of complications and death. Therefore, simple and reliable bedside tools are needed to better understand respiratory muscle function and to help predict weaning outcomes. This prospective, observational, single-center study aims to evaluate respiratory muscle function using bedside ultrasound in adult ICU patients with pneumonia receiving invasive mechanical ventilation. The diaphragm, parasternal intercostal muscles, and anterior scalene muscles will be assessed using ultrasound during the weaning process. Measurements will be performed serially, starting from the first day when patients demonstrate meaningful spontaneous breathing effort and continuing until successful extubation, tracheostomy, or ICU mortality. Ultrasound measurements of muscle thickness and thickening fraction will be analyzed in relation to weaning outcomes. In addition, ventilator parameters and commonly used weaning indices will be recorded at the time of each ultrasound assessment. The findings of this study are expected to improve understanding of respiratory muscle involvement during weaning and may contribute to earlier identification of patients at risk of weaning failure.
NCT06685406
Introduction Weaning from mechanical ventilation (MV) could be described as the process of removing ventilator support. Weaning from MV often implies two separate but closely linked views of care, elimination of MV of any artificial airway. Weaning from mechanical ventilation is a challenging step during recovery from critical illness (1). Earlier patient weaning from mechanical ventilation is recommended to avoid complications of prolonged mechanical ventilation; however, premature weaning might result in extubation failure which is associated with poor outcomes (2). The first step in weaning process is screening patients for readiness to be weaned from mechanical ventilation followed by the spontaneous breathing trial (SBT) by checking various indices carefully before starting SBT to ensure adequate oxygenation, ventilation, and airway reflexes (3). However, a percent of patients fail and are re-intubated despite fulfillment of all the current weaning criteria and this may be due to the heterogeneity of critically ill patients which impairs the predictive accuracy of the available indices in different patient subgroups (4). Various measures had been previously reported for evaluation of volume status such as fluid balance and echocardiography before the SBT aiming to identify patients who would benefit from diuretic therapy to achieve successful weaning from mechanical ventilation (5). Nowadays, there is an increasing interest in cardiac factors, such as lung congestion and hypervolemia, as contributing elements in weaning failure and that needs expert physician such as echocardiography (6). So thoracic fluid content measurement may also be beneficial, more accurate and could give us a good idea about weaning of patients from mechanical ventilation (7). Thoracic fluid content represents the whole (extravascular, intravascular, and intrapleural) fluid component in the thorax; thus, TFC was considered to provide an estimation of the extravascular lung water in absence of significant pleural or pericardial effusion (8,9). Trans-thoracic echocardiography is a non-invasive tool that delivers bedside cardiac function evaluation. Echocardiography is now widely used to evaluate cardiac function during the ventilator weaning process. Impaired left ventricular systolic and diastolic function were reported to be good predictors of weaning failure (10). Inferior vena cava (IVC) size and collapsibility can give us an idea about hypovolemic patients for estimation of right atrial pressure. Inferior vena cava diameter can be measured using the trans-thoracic echo-cardio graphic subcostal window in the sagittal plane. M-mode imaging allows high-frame rate measurements of size changes throughout the respiratory cycle (11). Trans-mitral to mitral annular early diastolic velocity ratio (E/Ea ratio) is an echo Doppler non invasive estimation of left ventricular filling pressures and can be measured using trans-thoracic echo-cardiograph in the apical four-chamber view then pulse-wave Doppler imaging is done to record trans-mitral and mitral annular flow in early diastole (12).
NCT07120438
The goal of this observational study is to evaluate the predictive value of diaphragmatic ultrasound compared to the Rapid Shallow Breathing Index (RSBI) in determining weaning success among mechanically ventilated patients in the ICU for more than 48 hours. The main question it aims to answer is: Which is more effective in predicting weaning success: diaphragmatic ultrasound (including Diaphragmatic Excursion \[DE\] and Diaphragm Thickening Fraction \[DTF\]) or RSBI, in patients ventilated \>48 hours in the ICU of Dr. Sardjito General Hospital, Yogyakarta? Participants will be adult ICU patients who are undergoing weaning from mechanical ventilation after more than 48 hours. Before extubation, each participant will undergo diaphragmatic ultrasound assessment to measure DE and DTF, along with RSBI measurement. The predictive accuracy of these parameters will be evaluated by comparing them with the actual weaning outcomes. Secondary objectives include: 1. Assessing whether diaphragmatic ultrasound is associated with a higher weaning success rate than RSBI. 2. Evaluating the correlation between DE values and successful weaning. 3. Determining the optimal cutoff values of DE and DTF as predictors of weaning failure. 4. Analyzing the incidence of weaning failure in patients who do not meet optimal diaphragm function criteria. 5. Identifying DE and DTF thresholds that may help reduce the risk of reintubation.
NCT06465082
The aim of this study is to assess the validity of the diaphragmatic thickening Fraction measured by ultrasound as a predictor for successful weaning from mechanical ventilation.
NCT06724302
The accuracy of ultrasound assessment of the thickening fraction of the diaphragm, parasternal intercostal, and abdominal expiratory muscles for predicting weaning outcomes in mechanically ventilated patients. A prospective observational study
NCT06642714
The aim of our study was to assess the feasibility of an early NIV and progressive HFOT through tracheostomy tube weaning protocol implemented by tracheostomized patients with PMV referred to a specialized weaning unit of a rehabilitation hospital.
NCT04792788
Liver transplantation is the treatment of choice for acute and chronic end-stage liver disease. Neurally Adjusted Ventilator Assist (NAVA) may be a feasible solution to guide the liberation from mechanical ventilation reducing asynchronies between patient and ventilator, and optimizing ventilator cycling. Cardiovascular and respiratory effects during NAVA ventilation are very limited after major abdominal surgery. The purpose of this application is to explore the efficacy of NAVA to reduce the asynchronies between the ventilator and pediatric patient admitted in Pediatric Intensive Care Unit (PICU) after major abdominal surgery, and the relationship between an optimal level of NAVA and cardiac and pulmonary function.
NCT01666054
The study hypothesis is that reducing patient-ventilator asynchrony will reduce time required to wean from mechanical ventilation. The purpose of this pilot study is (1) to assess study feasibility in terms of recruitment, protocol adherence and efficacy of the intervention for reducing asynchrony, (2) to assess baseline rates of asynchrony and outcomes in the control arm in order to perform sample size calculations, if needed, for further, larger studies designed to detect differences in weaning time in specific, predefined populations and (3) to examine how often ineffective triggering (and therefore reduced ventilator respiratory rate) at higher levels of pressure support lead to a false conclusion that higher levels of support are needed to diminish respiratory distress.
NCT01967108
The purpose of this study is to examine the efficacy of chest physiotheray treatment in preventing pulmonary complications and weaning faliure, in extubated critically ill patients.