Extubation, Mechanical Ventilation, Obesity &Amp; Overweight, Respiratory Failure
Conditions
Brief summary
This study aims to find out which method of spontaneous breathing trial (SBT) better helps overweight and obese ICU patients prepare for extubation, which is the removal of the breathing tube. The two methods being compared are pressure support ventilation (PSV) and the T-piece. Participants are adults with a body mass index (BMI) of 25 or higher who have been on a breathing machine (invasive mechanical ventilation) for more than 24 hours. Before removing the breathing tube, participants will be randomly assigned to receive either a PSV or a T-piece trial for 1 hour. After that, doctors will decide if they are ready for extubation. The main question this study wants to answer is: Which method leads to a higher rate of successful extubation-defined as not needing to be reintubated within 72 hours?
Interventions
PROCEDURESpontaneous breathing trial using pressure support ventilation
Patients will receive low level pressure support ventilation for 1 hour before extubation
PROCEDURESpontaneous breathing trial using T-Piece
Patients will receive a T-piece with oxygen for 1 hour before extubation
Sponsors
Taipei Medical University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1\. Patients had undergone intubation and mechanical ventilation for more than 24 hours prior to the first spontaneous breathing trial. 2\. Adult patients aged ≥ 18 years. 3. BMI ≥ 25 kg/m². 4. Meeting all the Inter national Consensus Conference on weaning criteria: 1. Stable vital signs: heart rate \< 140 beats/min, systolic blood pressure: 90-160 mmHg, and no use of vasopressors or use of minimal doses (\<0.2 µg/kg per min). 2. Respiratory rate ≤ 35 breaths/min. 3. Adequate oxygenation, defined as either SpO2 \> 90% with FiO2 ≤ 0.4, or PaO2/FiO2 \> 150 mmHg with positive end-expiratory pressure (PEEP) ≤ 8 cmH2O. 4. Adequate cough strength (MIP \< -20 cmH2O). 5. An awake state, defined as a score of Richmond Agitation-Sedation Scale between +1 and -2, or Glasgow Coma Scale \> 8. 6. No continuous sedation. 5. Informed consent provided by the patient or their relatives.
Exclusion criteria
1. Patients with tracheostomy. 2. Patients who had been admitted for traumatic brain injury. 3. Patients who had preexisting peripheral neuromuscular disease (underlying myopathy or myasthenia gravis). 4. Patients who had a do-not-reintubate order at the time of the initial spontaneous breathing trial were excluded 5. Patients who have already undergone a first spontaneous breathing trial. 6. Patients who had undergone extubation without an SBT 7. Protected populations: pregnant or breastfeeding women, individuals under guardianship, or those under legal protection. 8. Patients who refused to participate during the study.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Successful extubation within 72 hours | Within 72 hours after extubation |
Countries
Taiwan
Contacts
Primary ContactRespiratory therapist
Outcome results
None listed