mechanically ventilated patients with Obesity or central obesity
Conditions
Interventions
Sitting-position SBT group:Switch to a sitting position for SBT
Semirecumbent-position SBT group:Maintain the semirecumbent position for SBT
Sponsors
Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1.Age >=18 years; 2.Receiving invasive mechanical ventilation for >=24 hours; 3.Meeting the criteria for obesity and central obesity, defined as either of the following: BMI >=28 kg/m^2, plus at least one body habitus measurement meeting the following thresholds: waist circumference >=90 cm for men or >=85 cm for women; waist-to-hip ratio >=0.90 for men or >=0.85 for women; waist-to-height ratio >=0.50; or Regardless of BMI, at least two body habitus measurements meeting the following thresholds: waist circumference >=90 cm for men or >=85 cm for women; waist-to-hip ratio >=0.90 for men or >=0.85 for women; waist-to-height ratio >=0.50; 4.Through weaning screening, the evaluation criteria include: (1) Improvement or removal of the cause leading to mechanical ventilation; (2) Oxygenation indicators: PaO2/FiO2 >= 150 mmHg, PEEP = 7.35; for COPD patients, pH >= 7.30, FiO2 = 50 mmHg; (3) Hemodynamic stability, no dynamic changes of myocardial ischemia, clinically no significant hypotension (no or low-dose vasoactive drugs, MAP = 65 mmHg), heart rate 105; (2) RR 35 breaths/min; (3) Heart rate >140 beats/min or changes >20%, new onset arrhythmia; (4) Vt <4 ml/kg during spontaneous breathing; (5) SaO2 <90%. Or when patients show changes in mental status (such as drowsiness, coma, excitement, anxiety), sweating, increased work of breathing (using accessory respiratory muscles, paradoxical breathing). Subjects who successfully completed SBT were excluded; 6.Voluntary participation and signed informed consent. If a subject is unable to read or sign the informed consent form due to reasons such as lack of capacity, the informed consent process must be conducted by their guardian on their behalf, and the guardian must sign the informed consent form. If the subject is unable to read the informed consent form (e.g., illiterate subjects), a witness must witness the informed consent process and sign the informed consent form.
Exclusion criteria
Exclusion criteria: 1.Acute myocardial ischemia, severe arrhythmia, or requirement for high-dose vasoactive support; 2.Marked impaired consciousness or inability to cooperate (e.g., RASS <-2), or neuromuscular disease severely affecting spontaneous breathing; 3.Large volume of airway secretions, requiring frequent suctioning and ineffective cough for secretion clearance; 4.High risk of aspiration (e.g., persistent vomiting or uncontrolled upper gastrointestinal bleeding), or recent major thoracic or abdominal surgery limiting position change. 5.Back or spinal structural abnormalities preventing the patient from assuming a sitting position; 6.Unplanned extubation or situations requiring immediate extubation (e.g., endotracheal tube malposition or other special circumstances); 7.Vulnerable populations other than elderly, illiterate, or critically ill patients, such as patients with psychiatric disorders, cognitive impairment, or pregnant women; 8.Any other condition that, in the investigator’s judgment, makes the participant unsuitable for participation in this study.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Duration of invasive mechanical ventilation; | — |
Secondary
| Measure | Time frame |
|---|---|
| reintubation within 72 hours;ICU and total hospital stay;Respiratory failure after tube removal;Incidence of respiratory infections; | — |
Countries
China
Contacts
Public ContactHuiqing Ge
Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
Outcome results
None listed