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Browse 4,312 clinical trials for asthma. Find studies that match your criteria and connect with research centers.
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NCT02976233
Over the last two decades, non-invasive ventilation (NIV) has been widely reported as an effective method to avoid the need of endotracheal intubation (ETI) and improve survival in the acute care setting. Given the risks associated with either premature NIV discontinuation or delays in NIV interruption, evaluating readiness to weaning from NIV is a critical challenge in patients with Acute Respiratory Failure (ARF). Up to date, bedside measurements used to predict NIV outcomes are extremely limited. NIV weaning as well as decision of ETI are mainly supported by clinical and physiologic parameters. More sophisticated techniques used to predict weaning outcome during spontaneous breathing trials have never achieved a bedside broad-spectrum use due to their invasiveness, the inconsistent results in demonstrating reproducible outcomes, the requirements of additional trainee personnel and complicated equipment, and the difficult application in awake and non-intubated patients. Recently, ultrasound has been used for the rapid assessment of diaphragm function in acutely ill patients. The advantages of the ultrasound in detecting diaphragm dysfunction as compared with other techniques are the less invasiveness, the avoidance of radiation hazards and the bedside feasibility. Direct imaging of changes in diaphragm thickening (DT) during spontaneous breathing may provide the assessment of both the muscle and the respiratory pump functioning. Indeed, DT has been correlated with the diaphragm strength and the muscle shortening. The volume of diaphragm muscle mass remains constant while it contracts. Consequently, as the muscle shortens it thickens itself and measurements of changes in such a thickening (DT) are inversely related to changes in diaphragm length. Studies in patients with diaphragm paralysis have confirmed the absence of DT. Moreover, since the diaphragm is the major muscle of inspiration, the presence of diaphragm shortening and contraction may predict successful extubation in patients who are invasively ventilated. The aim of the present study is to assess whether DT as measured by ultrasound may predict NIV outcome in patients with de-novo ARF admitted to the Emergency Department (ED).
NCT02344043
Purpose of the Study Critical illness requiring life support affects over 150 000 people in Ontario every year. With aggressive support, the number of people who die from critical illness is decreasing. However, people who survive often have neurological problems. These neurological problems often include difficulties with memory, concentration, and attention. These problems are associated with poor quality of life among survivors of critical illness. The aim of this study is to identify the factors that contribute to these neurological deficits. Specifically, the investigators are testing whether changes in oxygen delivery to the brain during critical illness are related to both short- and long-term neurological complications. Procedures involved in the Research When patients are diagnosed with a critical illness such as shock or respiratory failure, they are treated with intravenous fluids, medications to raise their blood pressure, and can be placed on a ventilator to assist with their breathing. They are observed in an intensive care unit (ICU). This research protocol does NOT interfere with the normal treatment of patients with critical illness. The procedure involved in this research protocol requires the placement of two stickers to either side of the patient's forehead, and information about oxygen delivery to the brain will be recorded. When the patient has recovered from the critical illness, they will be asked to perform several neurological tests. Some of these tests will be done with a pencil and paper, while others will use a robotic device to test arm movements, reaction time, and concentration. Potential Harms, Risks or Discomforts: This research study involves the placement of a sticker sensor to either side of the forehead. Rarely, patients may develop a rash to these electrodes. The investigators monitor patients very carefully for rashes, and if a rash is to occur, the sticker sensor will be removed. With regards to the neurological testing, rarely patients can have some mild muscle stiffness after moving their arms in the robot. The investigators do not expect any other further harms, risks, or discomforts.