Visualization of Inspiratory Effort and Respiratory Mechanics to Promote Lung- and Diaphragm Protective Ventilation (VIREM)

Visualization of Inspiratory Effort and Respiratory Mechanics to Promote Lung- and Diaphragm Protective Ventilation

Visualization of Inspiratory Effort and Respiratory Mechanics to Promote Lung- and Diaphragm Protective Ventilation

Research Foundation Flanders, Universitaire Ziekenhuizen KU Leuven, The Hospital for Sick Children, University of Toronto, Universiteit Antwerpen, KU Leuven

This is a multicentre prospective cohort trial in adult and pediatric ICU patients. The investigators will measure the effect of a patient's inspiratory effort during mechanical ventilation on the lungs and diaphragm. The investigators will daily (for a maximum of 8 days) measure esophageal pressures with a balloon catheter to quantify inspiratory effort and respiratory muscle function, and perform daily ultrasound measurements of the diaphragm and the lungs. The investigators hypothesize that a small inspiratory effort will result in the preservation of diaphragm function and have no adverse effect on lung function.

A nasogastric balloon catheter will be inserted after inclusion. This will be a NutriVent (Sidam S.R.L., Mirandola, Italy) for patients >40kg, and a SmartCath Esophageal pressure catheter (Vyaire/Carefusion) for patients <40kg. This placement is similar to a standard nasogastric tube placement, which is a common procedure in an ICU. Potential minor side effects include a nosebleed, sore throat and erosion of the nose where the tube is anchored. All patients will receive this intervention. When the esophageal catheter becomes displaced or is accidentally removed during the study period, it will be replaced.

Our primary endpoint is the amount of total inspiratory muscle activity as represented by ∆Pes, measured at least once daily during the first 8 days of mechanical ventilation.

Our primary endpoint is the amount of total inspiratory muscle activity as represented by ∆Pes, measured at least once daily during the first 8 days of mechanical ventilation.

Our primary endpoint is the amount of total inspiratory muscle activity as represented by ∆Pes, measured at least once daily during the first 8 days of mechanical ventilation.

Our primary endpoint is the amount of total inspiratory muscle activity as represented by ∆Pes, measured at least once daily during the first 8 days of mechanical ventilation.

Our primary endpoint is the amount of total inspiratory muscle activity as represented by ∆Pes, measured at least once daily during the first 8 days of mechanical ventilation.

Our primary endpoint is the amount of total inspiratory muscle activity as represented by ∆Pes, measured at least once daily during the first 8 days of mechanical ventilation.

Our primary endpoint is the amount of total inspiratory muscle activity as represented by ∆Pes, measured at least once daily during the first 8 days of mechanical ventilation.

Our primary endpoint is the amount of total inspiratory muscle activity as represented by ∆Pes, measured at least once daily during the first 8 days of mechanical ventilation.

Measured with ultrasound. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

Measured with ultrasound. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

Measured with ultrasound. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

Measured with ultrasound. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

Measured with ultrasound. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

Measured with ultrasound. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

Measured with ultrasound. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

Measured with ultrasound. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

DTF is calculated as (Thickness at end-inspiration [DTei] - Thickness at end-expiration [DTee])/Thickness at end-expiration [DTee] × 100. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

DTF is calculated as (Thickness at end-inspiration [DTei] - Thickness at end-expiration [DTee])/Thickness at end-expiration [DTee] × 100. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

DTF is calculated as (Thickness at end-inspiration [DTei] - Thickness at end-expiration [DTee])/Thickness at end-expiration [DTee] × 100. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

DTF is calculated as (Thickness at end-inspiration [DTei] - Thickness at end-expiration [DTee])/Thickness at end-expiration [DTee] × 100. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

DTF is calculated as (Thickness at end-inspiration [DTei] - Thickness at end-expiration [DTee])/Thickness at end-expiration [DTee] × 100. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

DTF is calculated as (Thickness at end-inspiration [DTei] - Thickness at end-expiration [DTee])/Thickness at end-expiration [DTee] × 100. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

DTF is calculated as (Thickness at end-inspiration [DTei] - Thickness at end-expiration [DTee])/Thickness at end-expiration [DTee] × 100. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

DTF is calculated as (Thickness at end-inspiration [DTei] - Thickness at end-expiration [DTee])/Thickness at end-expiration [DTee] × 100. The ultrasound probe will be positioned perpendicular to the skin at the right zone of apposition.

From date of intubation until the date of extubation or date of death from any cause, whichever came first, assessed up to 4 months

MIP is a measure of inspiratory function. Measured once daily during an expiratory hold (± 30 seconds)

MIP is a measure of inspiratory function. Measured once daily during an expiratory hold (± 30 seconds)

MIP is a measure of inspiratory function. Measured once daily during an expiratory hold (± 30 seconds)

MIP is a measure of inspiratory function. Measured once daily during an expiratory hold (± 30 seconds)

MIP is a measure of inspiratory function. Measured once daily during an expiratory hold (± 30 seconds)

MIP is a measure of inspiratory function. Measured once daily during an expiratory hold (± 30 seconds)

MIP is a measure of inspiratory function. Measured once daily during an expiratory hold (± 30 seconds)

MIP is a measure of inspiratory function. Measured once daily during an expiratory hold (± 30 seconds)

From date of inclusion until the date of reintubation or date of hospital discharge or date of death from any cause, whichever came first, assessed up to 4 months.

From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 4 months

From date of inclusion until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 4 months

From date of hospital admission until the date of hospital discharge or date of death from any cause, whichever came first, assessed up to 4 months

From date of intubation until the date of death from any cause, whichever came first, assessed up to 4 months

From date of inclusion until the date of hospital discharge or date of death from any cause, whichever came first, assessed up to 4 months

From date of inclusion until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 4 months

From date of inclusion until the date of hospital discharge or date of death from any cause, whichever came first, assessed up to 4 months

From date of ICU discharge until the date of hospital discharge or date of death from any cause, whichever came first, assessed up to 4 months

Area under the curve (AUC) of the Pes-time plot during inspiration. Measured at least once daily for the first 8 days of mechanical ventilation.

Area under the curve (AUC) of the Pes-time plot during inspiration. Measured at least once daily for the first 8 days of mechanical ventilation.

Area under the curve (AUC) of the Pes-time plot during inspiration. Measured at least once daily for the first 8 days of mechanical ventilation.

Area under the curve (AUC) of the Pes-time plot during inspiration. Measured at least once daily for the first 8 days of mechanical ventilation.

Area under the curve (AUC) of the Pes-time plot during inspiration. Measured at least once daily for the first 8 days of mechanical ventilation.

Area under the curve (AUC) of the Pes-time plot during inspiration. Measured at least once daily for the first 8 days of mechanical ventilation.

Area under the curve (AUC) of the Pes-time plot during inspiration. Measured at least once daily for the first 8 days of mechanical ventilation.

Area under the curve (AUC) of the Pes-time plot during inspiration. Measured at least once daily for the first 8 days of mechanical ventilation.

Measured with volumetric capnography (Capnostat 5, Philips) in adults only. Measured at least once daily for the first 8 days of mechanical ventilation.

Measured with volumetric capnography (Capnostat 5, Philips) in adults only. Measured at least once daily for the first 8 days of mechanical ventilation.

Measured with volumetric capnography (Capnostat 5, Philips) in adults only. Measured at least once daily for the first 8 days of mechanical ventilation.

Measured with volumetric capnography (Capnostat 5, Philips) in adults only. Measured at least once daily for the first 8 days of mechanical ventilation.

Measured with volumetric capnography (Capnostat 5, Philips) in adults only. Measured at least once daily for the first 8 days of mechanical ventilation.

Measured with volumetric capnography (Capnostat 5, Philips) in adults only. Measured at least once daily for the first 8 days of mechanical ventilation.

Measured with volumetric capnography (Capnostat 5, Philips) in adults only. Measured at least once daily for the first 8 days of mechanical ventilation.

Measured with volumetric capnography (Capnostat 5, Philips) in adults only. Measured at least once daily for the first 8 days of mechanical ventilation.

Inclusion Criteria: age > 28 days weight > 3kg requiring invasive mechanical ventilation anticipated length of ventilation > 48h Exclusion Criteria: refusal of consent mechanical ventilation ≤ 2 weeks before inclusion known anatomical malformation of the diaphragm (including congenital diaphragmatic hernia) contra-indication to the placement of a naso-gastric esophageal balloon catheter