Brain-injury, Stroke, Structural Coma, Subarachnoid Haemorrhage, Traumatic Brain Injury
Conditions
Brief summary
Protective ventilation (association of a tidal volume \< 8 ml/kg with a positive end expiratory pressure) is poorly used in severe brain-injured patients. Moreover, a systematic approach to extubation may decrease the rate of extubation failure and enhance outcomes of brain-injured patients. We hypothesized that medical education and implementation of an evidence-base care bundle associating protective ventilation and systemic approach to extubation can reduce the duration of mechanical ventilation in brain-injured patients.
Detailed description
A before/after study design will be used. The before period (control phase) will consisted of all consecutive patients with severe brain-injury who were admitted to the participating ICUs. During the interphase, all physicians, residents, physiotherapists and nurses will receive a formal training for the processes and procedures related to the 2 point bundle: protective ventilation and systematic approach to extubation (according to recommendation for the use of tidal volume \< 7 ml/kg and of a positive expiratory pressure = 6 to 8 cmH20 (centimeter of water) and extubation as soon as ventilatory weaning is associated with a glasgow coma scale equal or above 10 and cought). The after period consisted of all consecutive severe brain-injured patients admitted to the participating ICUs after the formal training.
Interventions
OTHERPass recommendations on ventilation factors and extubation
* the use of tidal volume \< 7 ml/kg and of a positive expiratory pressure = 6 to 8 cmH20 (centimeter of water) * extubation as soon as ventilatory weaning is associated with a glasgow coma scale equal or above 10 and cough
Sponsors
Nantes University Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients (traumatic brain-injured, subarachnoid hemorrhage, stroke or other) * Brain injury (Glasgow Coma Scale ≤ 12 associated with at least one anomaly related to an acute process on head tomographic tomodensitometry * mechanical ventilation for more than 24 hours
Exclusion criteria
* early decision to withdraw care (taken in the first 24 hours in ICU), * death in the first 24 hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mechanical ventilatory free days | Day-90 | The number of ventilator-free days was defined as the number of days from day 1 to day 90 on which a patient breaths spontaneously and is alive |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| In-ICU mortality | 90 days | — |
| Duration of mechanical ventilation | 90 days | — |
| ICU free days at day 90 | day 90 | The number of ICU free days was defined as the number of days from day 1 to on which a patient is alive and not hospitalized in ICU |
| Acute respiratory distress syndrome / acute lung injury | day-90 | — |
| Hospital acquired pneumonia | day-90 | — |
| Mortality | day-90 | — |
| Intracranial pressure | day-5 | — |
| Glasgow outcome scale | day-90 | — |
| Extubation failure | day-90 | — |
| Ventilatory setting | day-5 | Tidal volume and Positive end expiratory pressure |
| Blood gaz | day-5 | PaO2 (arterial pressure of oxygen) and PaCO2 (arterial pressure of dioxide of carbon) |
Countries
France
Outcome results
None listed