Expiratory Muscle Function in Critically Ill Ventilated Patients (EMFIC)
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.
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Tipo di studio
Iscrizione (Effettivo)
Contatti e Sedi
Luoghi di studio
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Noord-Holland
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Amsterdam, Noord-Holland, Olanda, 1081HV
- VU University Medical Center
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Metodo di campionamento
Popolazione di studio
Descrizione
Inclusion Criteria:
- Age > 18 years
- Invasive mechanical ventilation < 48 hours
- Expected duration of mechanical ventilation > 72 hours
Exclusion Criteria:
- Past medical history of neuromuscular disorders
- Mechanical ventilation > 48 hours within the current hospital admission
- Pregnant women
- Open abdominal wounds at proposed location of the ultrasound probe, due to recent abdominal surgery
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Abdominal expiratory muscle thickness
Lasso di tempo: 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
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Thickness of the abdominal expiratory muscles measured in millimeters
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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
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Diaphragm muscle thickness
Lasso di tempo: 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
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Thickness of the diaphragm muscle measured in millimeters
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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
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Inflammatory markers
Lasso di tempo: Within 24 hours after inclusion
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Inflammatory markers (TNF-alpha, IL-6, IL-10) at inclusion (measured from blood sample using ELISA technique).
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Within 24 hours after inclusion
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Applied driving pressure
Lasso di tempo: 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
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Appplied driving pressuye defined as peak pressure minus total postive end expiratory pressure, and measured in centimetre of water
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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
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Tidal volume
Lasso di tempo: 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
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Tidal volume measured in liters
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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
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Positive end expiratory pressure
Lasso di tempo: 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
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Postive end expiratory pressure measure in centimetre of water
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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
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Extubation failure
Lasso di tempo: 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
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Reintubated after extubation
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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
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Readmission to ICU
Lasso di tempo: 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
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Readmitted to ICU after the ICU discharge
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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
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Collaboratori e investigatori
Sponsor
Investigatori
- Investigatore principale: Leo M Heunks, Amsterdam UMC, location VUmc
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Inizio studio (Effettivo)
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Completamento dello studio (Effettivo)
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Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- EMFIC
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