Guillain-Barre Syndrome
Conditions
Brief summary
The aim of the current study is to compare the effect of ventilator trigger sensitivity adjustment versus threshold inspiratory muscle training on arterial blood gases in mechanically ventilated patients.
Detailed description
Failed extubations are not uncommon in most ICUs, the failure rate ranging from 2 to 20%. Since failed extubation is associated with greater hospital morbidity and mortality and longer length of stay, it is imperative to identify screening techniques that minimize the number of failed extubations. Many studies have been done on the effect of IMT by threshold IMT and adjustment of mechanical ventilator trigger separately, thereby, it is rational to compare between two methods of training to know which is more effective to help in weaning process through its effect on ABGs.
Interventions
OTHERThreshold inspiratory muscle trainer or ventilator pressure setting inspiratory muscle training techniques
New techniques to train inspiratory muscles in mechanically ventilated patients
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
1. Difficult to wean Guillain barre patients who have been on MV for at least 48 hours. Difficult to wean subjects have been defined as those who fail the first spontaneous breathing trial (SBT)and may require up to 3 SBTs or up to 7 d from the first attempt to achieve successful weaning (B´eduneau G. et al.,2017) and (Annia F. et al.,2019). 2. Age: \>18 years. 3. Both sexes will be included. 4. Ventilator mode: Pressure support mode with FiO2≤ 0.5, positive end expiratory pressure (PEEP) will be\<8-10cm/H2Oand respiratory rate \< 25. 5. Conscious oriented patient with Glasgow coma score ≥13. 6. Alertness will be titrated to a Riker Sedation Agitation Score of 4. 7. PH\>7.25, arterial oxygen saturation \>90%. 8. Cardiovascular stability. 9. Maximal inspiratory pressure from 15 to 30 cm H2O and able to trigger spontaneous breaths on ventilator.
Exclusion criteria
1. Persistent hemodynamic instability as life threatening arrhythmias, acute heart failure. 2. Severe breathlessness, when spontaneously breathing. 3. Any progressive neuromuscular disease that would interfere with responding to inspiratory muscle training (non-stationary course). 4. Spinal cord injury. 5. Skeletal pathology (scoliosis, flail chest, spinal instrumentation) that would seriously impair the movement of the chest wall and ribs. 6. Patients on heavy sedation and respiratory muscle paralysis. 7. High peak airway pressure (barotraumas). 8. BMI ≥ 40.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PH | Pre intervention and immediate post intervention, through study completion, an average of two weeks | To measure PH |
| PaO2 | Pre intervention and immediate post intervention, through study completion, an average of two weeks | To measure partial pressure of oxygen |
| PaCO2 | Pre intervention and immediate post intervention, through study completion, an average of two weeks | To measure partial pressure of carbon dioxide |
| HCO3 | Pre intervention and immediate post intervention, through study completion, an average of two weeks | To measure bicarbonate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Respiratory rate | Pre intervention and immediate post intervention, through study completion, an average of two weeks | Number of breath cycles per minute |
| Rapid shallow breathing index | Pre intervention and immediate post intervention, through study completion, an average of two weeks | To measure respiratory endurance |
| Weaning success rate | post intervention at the end of the study, an average of two weeks | Number of patients weaning from MV |
| Minute ventilation | Pre intervention and immediate post intervention, through study completion, an average of two weeks | The amount of air that enters the lungs per minute. |
| The Horowitz index | Pre intervention and immediate post intervention, through study completion, an average of two weeks | To measure PaO2 /FiO2 ratio |
| Glasgow coma scale | Pre intervention and immediate post intervention, through study completion, an average of two weeks | To measure level of consciousness |
| Riker Sedation-Agitation Scale | Pre intervention and immediate post intervention, through study completion, an average of two weeks | Arousal/sedation assessment |
Countries
Egypt
Contacts
Primary ContactElmasry
Outcome results
None listed