2026-04-17T15:41:30Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/118872025-10-24T10:23:35Zcom_2072_451665com_2072_378040com_2072_378070col_2072_451666col_2072_378092

00925njm 22002777a 4500 dc Rognoni, Gina author García, Carolina author Cabañes, Sara author de la Torre, Maria author Pedrós, Cristina author Subira, Carles author baquerizo vargas, herbert glenny author 2024-08-30T07:46:42Z 2024-08-30T07:46:42Z 2024-07-16 Extubation; Lung ultrasound; Mechanical ventilation Extubación; Ecografía pulmonar; Ventilación mecánica Extubació; Ecografia pulmonar; Ventilació mecànica Background: In standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation. Methods: This multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization. Discussion: We aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients. This study received funding from “Fundación Española del Enfermo Crítico FEEC” through a research project award in December 2022 (€10,000). FEEC did not participate in the design of the study http://hdl.handle.net/11351/11887 Pulmons - Ecografia Respiració artificial Assaigs clínics ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Airway Management::Respiration, Artificial ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Airway Management::Airway Extubation PUBLICATION CHARACTERISTICS::Study Characteristics::Clinical Study::Clinical Trial TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::manejo de la via aérea::respiración artificial TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::manejo de la via aérea::extubación de la vía aérea CARACTERÍSTICAS DE PUBLICACIONES::características del estudio::estudio clínico::ensayo clínico Effect of lung volume preservation during spontaneous breathing trial on successful extubation in patients receiving mechanical ventilation: protocol for a multicenter clinical trial