Sistema de Salut de Catalunya
[Subirà C] Servei de Medicina Intensiva, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain. Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain. CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain. [Rognoni G, Baquerizo H] Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain. Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain. Programa de Doctorat en Medicina I Ciències Biomèdiques, Universitat de Vic- Universitat Central de Catalunya (UVIC-UCC), Vic, Spain. [García C] Servicio de Medicina Intensiva, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain. [Cabañes S] Servicio de Medicina Intensiva, Txagorritxu Hospital Universitario Araba, Gasteiz, Spain. [de la Torre M] Servei de Medicina Intensiva, Hospital de Mataró, Mataró, Spain. [Pedrós C] Servei de Medicina Intensiva, Hospital General de Granollers, Granollers, Spain
Hospital General de Granollers
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
Article
Published version
English
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
BMC
Trials;25(1)
https://doi.org/10.1186/s13063-024-08297-1
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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