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This study aims to evaluate the effectiveness of ultrasound-based diaphragmatic measurements in predicting weaning success in patients aged 65 and older who are receiving mechanical ventilation. Additionally, it seeks to contribute to the clinical decision-making process by examining the relationship between these measurements and conventional weaning parameters.
Weaning refers to the gradual reduction of mechanical ventilatory support. Approximately 40% of the time patients spend on mechanical ventilation is dedicated to the weaning process. Patients who fail the spontaneous breathing trial (SBT) or require reintubation within 48 hours after extubation are considered to have experienced weaning failure. Around 20-30% of patients receiving invasive mechanical ventilation are classified as difficult to wean.
In the geriatric population, the weaning process becomes even more challenging due to age-related changes such as decreased lung elasticity, reduced muscle mass, and diminished lung volumes. Although various scales have been developed to predict weaning success, their correlation with actual clinical outcomes remains uncertain.
The diaphragm is the primary muscle involved in active inspiration. Dysfunction of the diaphragm can lead to impaired cough reflex and respiratory failure. In recent years, ultrasonography (US) has been used to assess diaphragmatic thickness and movement through the right hemithorax during inspiration and expiration. From these measurements, parameters such as Diaphragm Thickness during inspiration and expiration (DTi and DTe), Diaphragm Thickening Fraction (DTF), and Diaphragm Excursion (DE) can be calculated. Several studies have investigated the association between these parameters and weaning success.
In this planned study, the investigators aim to evaluate the predictive value of ultrasound-derived diaphragmatic parameters (DTi, DTe, DTF, and DE) for weaning success in geriatric patients who are intubated and monitored in intensive care units. Additionally, investigators intend to assess the correlation between these parameters and other respiratory indicators.
The primary objective of this study is to examine the relationship between diaphragmatic parameters measured via ultrasonography within 24 hours prior to weaning and weaning outcomes in intubated ICU patients aged 65 years and older. The secondary objective is to compare the correlation of these parameters with other conventional respiratory parameters.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Weaning Success Group | Patients who are weaned from mechanical ventilation within 24 hours of diaphragmatic ultrasound measurements and didn't need mechanical ventilation again for at least 48 hours was placed in this group. | ||
| Weaning Failure Group | Patients who are weaned from mechanical ventilation within 24 hours of diaphragmatic ultrasound measurements but needed mechanical ventilation support again within 48 hours after weaning was placed in this group. |
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| Measure | Description | Time Frame |
|---|---|---|
| Diaphragm Thickness Measurement | Diaphragm thicknesses are measured with linear ultrasound probe at 8-10th intercostal space on anterior or middle axillary line using B-mode during inspiration and expiration. | Within 24 hours prior to weaning from mechanical ventilation. |
| Diaphragmatic Excursion Measurement | Diaphragmatic excursion is measured with convex probe at midclavicular line just below costal arch using M-mode during respiratory cycle. | Within 24 hours prior to weaning from mechanical ventilation. |
| Diaphragm Thickening Fraction | Diaphragmatic thickening fraction is calculated by taking the difference between diaphragm thickness at end-inspiration and diaphragm thickness at end-expiration, dividing it by the thickness at end-expiration, and multiplying by 100 to get a percentage. | Within 24 hours prior to weaning from mechanical ventilation. |
| Measure | Description | Time Frame |
|---|---|---|
| Arterial Blood Gas | pH, Partial Pressure of Carbon Dioxide (mmHg) , Partial Pressure of Oxygen (mmHg), Oxygen Saturation(SaO2) values from arterial blood gas will be collected. | Within 24 hours prior to weaning from mechanical ventilation. |
| Oxygen Saturation |
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Inclusion Criteria:
Exclusion Criteria:
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Patients admitted to the intensive care unit of Kartal Dr. Lutfi Kirdar Training and Research Hospital who are 65 years or older and underwent mechanical ventilation
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Health Sciences Kartal Dr. Lutfi Kirdar City Hospital | Istanbul | 34865 | Turkey (Türkiye) |
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Peripheral Oxygen Saturation Percentage |
| Within 24 hours prior to weaning from mechanical ventilation |
| Respiratory Rate (Breaths per Minute) | Respiratory rate per minute will be collected. | Within 24 hours prior to weaning from mechanical ventilation |
| Rapid Shallow Breathing Index (Breath/Minute/L) | RSBI will be calculated by dividing respiratory rate per minute to tidal volume in liters. | Within 24 hours prior to weaning from mechanical ventilation |
| Mechanical Ventilation Duration (Hours) | Mechanical ventilation duration prior to the weaning trial of the patients was recorded in hours. | Within 24 hours prior to weaning from mechanical ventilation |
| PaO2/FiO2 (mmHg) | PaO2 from arterial blood gas analysis was divided by fractional inspired oxygen to calculate this value. | Within 24 hours prior to weaning from mechanical ventilation. |
| Tidal Volume and Minute Ventilation (L) | These values were collected from mechanical ventilator. | Within 24 hours prior to weaning from mechanical ventilation. |
| P0.1 (cmH2O) | P0. 1 is the negative airway pressure generated by the patient during the first 0.1 s against an occluded airway. P0. 1 can be obtained non-invasively in most new generation mechanical ventilators through a simple maneuver. | Within 24 hours prior to weaning from mechanical ventilation. |
| Dynamic Compliance (mL/cmH2O) | Dynamic compliance is measured by dividing the tidal volume, the average volume of air in one breath cycle, by the difference between the pressure of the lungs at full inspiration and full expiration. These values were collected from mechanical ventilator. | Within 24 hours prior to weaning from mechanical ventilation. |