Lung Volume Preservation During Extubation

Launched by ALTHAIA XARXA ASSISTENCIAL UNIVERSITÀRIA DE MANRESA · Aug 30, 2022

Keywords

ClinConnect Summary

This clinical trial is studying two different methods to help patients come off mechanical ventilation more successfully. When patients are ready to stop using the ventilator, they typically undergo a test called a spontaneous breathing trial (SBT). In this trial, researchers want to compare a standard method that involves some suctioning (to clear secretions) with an experimental method that does not use suctioning at all. The goal is to see which method helps keep the lungs more open and functioning well, which may lead to a higher chance of successfully stopping the ventilator.

Eligible participants are adults over 18 years who have been on mechanical ventilation for more than 24 hours and meet specific health conditions, such as being stable, having a good cough, and showing improvement in the condition that required breathing support. Those who join the trial can expect to be randomly assigned to one of the two methods and will have their lung function checked using a non-invasive ultrasound. It’s important to note that this study is currently recruiting participants and seeks to determine not only the success rates of the two methods but also the overall health and recovery of patients in the intensive care unit.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients\> 18 years who meet weaning criteria (see below)
• • More than 24 hours of mechanical ventilation (MV)
• • Signed Informed Consent by a substitute decision maker (SDM).
• Weaning Criteria:
• • Suitable cough (Ability to raise secretions to the endotracheal tube) (or Maximal inspiratory pressure (MIP) \< -15 cmH2O).
• • Absence of excessive secretions (\<3 aspirations in the last 8 hours).
• • Resolution or improvement of the pathology that led to intubation.
• • Clinical stability (Heart Rate (HR) \<140 bpm, Systolic Blood Pressure (SBP) 90-160, without vasopressors or at minimum doses).
• • Adequate oxygenation (SatO2\> 90% with Inspiratory Fraction of oxygen (FiO2) \<0.4).
• • Adequate ventilatory mechanics (Respiratory rate (RR) \<35 rpm, Tidal Volume (TV) \> 5 ml / kg, RR / TV \<100 rpm/l).
• • Confident awareness level (Glasgow Coma Scale (GCS)\> 13).
• Exclusion Criteria:
• • tracheostomy, do-not-reintubate orders, decision of the responsible physician (e.g., due to a preference for a particular weaning technique according to the underlying pathology), absence of informed consent, mental incapacity without legal representation.
• • For ultrasound assessment: skilled explorer not present at the time of the SBT, inadequate ultrasound window. Known diaphragmatic paralysis.