Comparison of Two Methods for Assessing Cough Capacity in Intensive Care Unit After Cardiac Surgery

NCT03983044 | Completed

• 1 other identifier: 2018-A01114-51
• Study Type: observational
• Target: 44
• Locations: 1 country
• Sites: 1

Brief Summary

Weaning from mechanical ventilation represents 50% of the time spent under mechanical ventilation (1). The risk factors identified in the failure to wean from mechanical ventilation are:

• left heart dysfunction with LVEF \< 30%.
• an ineffective cough
• presence of resuscitation neuromyopathy
• mechanical ventilation time \>7 days
• presence of a delirium
• age \>65 years old
• abundant bronchial secretion
• presence of underlying lung pathology An ineffective cough is found in 40% of patients requiring reintubation. However, cough assessment is most often approximate, based on a subjective assessment of cough strength by asking the patient to cough spontaneously on his or her tube). The objective evaluation of cough is based on the measurement of the peak expiratory flow rate at cough, commonly referred to as peak expiratory flow rate at cough (PEFD), the patient is asked to take a deep breath and then cough as hard as possible. Subjective cough assessment does not predict the occurrence of ventilatory withdrawal failure. Conversely, all studies that objectively assessed the strength of cough before extubation by measuring the PEFD found a significant association with the outcome of extubation: a low PEFD increases the risk of extubation failure by a factor of 5 to 9. The investigators hypothesize that the increase in parietal abdominal muscle contraction obtained by using a non-invasive ultrasound method indicates an effective cough. Conversely, an ineffective cough can be detected by this simple ultrasound criterion, which can be performed at the patient's bedside and extrapolated to all intensive care units equipped with an ultrasound scanner. This evaluation will be carried out before extubation: during the spontaneous ventilation test on a tube in a half-seated position (\>45°) and within 24 hours after extubation.

Conditions

Intensive Care Unit; Cardiac Surgery

Keywords

cough evaluation; intensive care unit; utrasound evaluation

Outcome Measures

Primary Outcomes (2)

• parietal ultrasound

  compare parietal ultrasound with peak expiratory flow rate measurement (PEFD) in patients ventilated less than 48 hours after cardiac surgery with a sternal approach.

  48 hours

• peak expiratory flow rate

  compare parietal ultrasound with peak expiratory flow rate measurement (PEFD) in patients ventilated less than 48 hours after cardiac surgery with a sternal approach.

  48 hours

Eligibility Criteria

• Age: 18 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patient admitted to intensive care, intubated after cardiac surgery by sternotomy.

You may qualify if:

• Major patients admitted for intubated resuscitation, ventilated after sternotomy cardiac surgery and having a mechanical ventilation time of less than 48 hours.

You may not qualify if:

• Pregnant patient
• Recent history of stroke(\<6 months )
• Minor patient
• Neurological disorder (Alzheimer's disease, delirium, confusion)
• Emphysemal patient

Sponsors & Collaborators

• Centre Chirurgical Marie Lannelongue: lead

Study Sites (1)

Centre Chirurgical Marie Lannelongue

Le Plessis-Robinson, 92350, France

Location

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 6, 2019
• First Posted: June 12, 2019
• Study Start: October 9, 2018
• Primary Completion: July 9, 2019
• Study Completion: July 9, 2019
• Last Updated: January 23, 2020

Record last verified: 2019-05

Data Sharing

• IPD Sharing: Will not share

Locations

FR (1)