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.
調査の概要
研究の種類
入学 (実際)
連絡先と場所
研究場所
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Noord-Holland
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Amsterdam、Noord-Holland、オランダ、1081HV
- VU University Medical Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
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
研究計画
研究はどのように設計されていますか？
デザインの詳細
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Abdominal expiratory muscle thickness
時間枠：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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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Diaphragm muscle thickness
時間枠：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
時間枠：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
時間枠：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
時間枠：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
時間枠：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
時間枠：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
時間枠：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
|
協力者と研究者
捜査官
- 主任研究者：Leo M Heunks、Amsterdam UMC, location VUmc
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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