Atelectasis, Mechanical Ventilation
Conditions
Keywords
Atelectasis, Mechanical Ventilation, Airway Secretion Retention
Brief summary
The goal of this clinical trial is to learn whether bedside flexible bronchoscopy-guided airway clearance can improve lung aeration in adult patients who are receiving invasive mechanical ventilation and have atelectasis with a high airway secretion burden. The main questions it aims to answer are: Does bedside flexible bronchoscopy-guided airway clearance reduce the proportion of nonaerated lung tissue from baseline to day 5? Does this treatment improve other lung aeration measures, respiratory mechanics, arterial blood gas parameters, pulmonary infection score, ventilator-free days, intensive care unit length of stay, and safety outcomes? Researchers will compare usual airway care plus bedside flexible bronchoscopy-guided airway clearance with usual airway care alone to see if bronchoscopy-guided airway clearance improves lung aeration and clinical outcomes. Participants will be randomly assigned to one of two groups. Participants in the usual care group will receive standard airway management, which may include airway suctioning, postural drainage, humidification, chest physiotherapy, and other routine respiratory care. Participants in the bronchoscopy group will receive the same usual care, plus bedside flexible bronchoscopy-guided airway clearance when predefined criteria for high airway secretion burden are met. Participants will have clinical assessments during the study, including chest imaging, respiratory mechanics measurements, arterial blood gas tests, pulmonary infection score assessment, and safety monitoring. The main assessment will compare quantitative chest computed tomography findings at baseline and day 5 to evaluate changes in nonaerated lung tissue.
Interventions
PROCEDUREFlexible Bronchoscopy-Guided Airway Clearance
Bedside flexible bronchoscopy-guided airway clearance will be performed through the artificial airway in mechanically ventilated participants. The procedure will be used to inspect the tracheobronchial tree and remove retained airway secretions or mucus plugs by targeted suctioning. Small-volume saline lavage may be used when secretions are thick or difficult to remove. The intervention will be performed in addition to usual airway care when predefined criteria for high airway secretion burden are met. After the procedure, ventilator settings will be restored according to the study protocol and the participant's clinical condition.
OTHERUsual Airway Care
Usual airway care may include airway suctioning, postural drainage, chest physiotherapy, mechanical airway clearance techniques, humidification and heating of inhaled gas, cuff pressure monitoring, and timely clearance of airway secretions according to routine clinical practice.
Sponsors
Southeast University, China
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age 18 years or older 2. Receiving invasive mechanical ventilation for at least 48 hours 3. Presence of atelectasis confirmed by chest computed tomography, chest X-ray, or lung ultrasound 4. High airway secretion burden, defined as requiring airway suctioning at least twice per hour during the previous 8 hours 5. Written informed consent obtained from the participant or legally authorized representative
Exclusion criteria
1. Expected duration of artificial airway maintenance less than 5 days 2. Untreated tension pneumothorax Known or suspected aspiration 3. Active intrapulmonary hemorrhage 4. Severe dysfunction of other organs with expected short-term mortality within 7 days or need for palliative care 5. Any other condition judged by the medical team to make the participant unsuitable for the study 6. Informed consent not obtained
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percent Change in CT-assessed Nonaerated Lung Percentage From Baseline to Day 5 | Baseline to Day 5 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent Change in CT-assessed Normally Aerated Lung Percentage From Baseline to Day 5 | Baseline to Day 5, with chest CT performed within 24 hours of each time point | — |
| Change in static respiratory system compliance from baseline to Day 5 | Baseline to Day 5 | Static respiratory system compliance will be measured under controlled mechanical ventilation. The change from baseline to Day 5 will be calculated as the Day 5 value minus the baseline value. |
| Change in driving pressure from baseline to Day 5 | Baseline and Day 5 | Driving pressure will be calculated as plateau pressure minus positive end-expiratory pressure. The change from baseline to Day 5 will be calculated as the Day 5 value minus the baseline value. |
| Change in plateau pressure from baseline to Day 5 | Baseline and Day 5 | Plateau pressure will be recorded during mechanical ventilation. The change from baseline to Day 5 will be calculated as the Day 5 value minus the baseline value. |
| Change in PaO2/FiO2 ratio from baseline to Day 5 | Baseline and Day 5 | — |
| Ventilator-free days within 28 days after randomization | From randomization to Day 28 | Ventilator-free days are defined as the number of days alive and free from invasive mechanical ventilation during the first 28 days after randomization. Patients who die before Day 28 will be assigned zero ventilator-free days. Patients who remain on invasive mechanical ventilation for 28 days or longer will also be assigned zero ventilator-free days. For patients successfully liberated from invasive mechanical ventilation and alive at Day 28, ventilator-free days will be calculated as 28 minus the number of days receiving invasive mechanical ventilation. |
| All-cause mortality within 28 days after randomization | From randomization to Day 28 | All-cause mortality will be defined as death from any cause occurring within 28 days after randomization. |
| Length of stay in the intensive care unit | From randomization to ICU discharge or death, assessed up to 28 days | — |
Contacts
CONTACTMengyuan Shen, MD
PRINCIPAL_INVESTIGATORLing Liu, PHD
Zhongda Hospital, School of Medicine, Southeast University
Outcome results
None listed