Patients With Acute Hypoxemic Respiratory Failure
Conditions
Brief summary
The main purpose of the present study is to verify whether, as compared with conventional weaning, early weaning with high-flow nasal cannula oxygenation or noninvasive positive pressure ventilation may more effective in shortening the duration of invasive ventilation, hence reducing the rates of complications and mortality in patients with acute hypoxemic respiratory failure.
Interventions
High-flow nasal cannula oxygenation will be applied immediately after early extubation, with a gas flow rate of 50 liters per minute and a fraction of inspired oxygen of 1.0 at initiation. The fraction of inspired oxygen will be subsequently adjusted to maintain a peripheral oxygen saturation of 92% or more.
Noninvasive positive pressure ventilation will be applied immediately after early extubation, with a noninvasive ventilator (Respironics V60, Philips) using the NIPSV mode at initiation. The fraction of inspired oxygen will be adjusted to achieve SpO2 \>92% with an initial expiratory positive airway pressure (EPAP) of 4 cmH2O. EPAP will be increased gradually in increments of 1-2 cmH2O, up to a maximum of 12 cmH2O, to achieve SpO2 \>96%. Inspiratory positive airway pressure (IPAP) will be initially set at 8 cmH2O and be increased gradually in increments of 1-2 cmH2O according to patients' tolerance to obtain a tidal volume (VT) of 6-8 mL/kg.
DEVICEConventional weaning
The patients will undergo conventional weaning protocol. Extubation and subsequent oxygen therapy with venturi mask will be performed after successful spontaneous trial.
Sponsors
Beijing Chao Yang Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Orotracheal intubation； 2. PaO2 \<60mmHg（venturi mask，FiO2=0.5），and PaCO2 ≤45mmHg； 3. Meeting criteria for weaning readiness； 4. Spontaneous breathing trial failure.
Exclusion criteria
1. Age\<18； 2. Duration of invasive ventilation \<48h； 3. Tracheotomy； 4. Percentage of cuff leak volume in tidal volume\<15.5%； 5. Unable to spontaneously clear secretions from their airway； 6. Recent oral，nasal，facial or cranial trauma or surgery； 7. Recent gastric or esophageal surgery； 8. Active upper gastro-intestinal bleeding； 9. Severe abdominal distension； 10. Lack of co-operation； 11. Chronic respiratory disease such as chronic obstructive pulmonary disease, asthma, interstitial lung disease and neuromuscular disease.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Duration of invasive mechanical ventilation | 2.5 years |
Countries
China
Contacts
Primary ContactZujin Luo, MD
Outcome results
None listed