Weaning Mechanical Ventilation
Conditions
Keywords
ICU, MEchanical ventilation
Brief summary
Weaning from invasive mechanical ventilation (IMV) is a critical stage of the intensive care unit (ICU) stay. Premature IMV discontinuation may expose patients to substantial cardiopulmonary stress, whereas prolonged weaning increases exposure to complications associated with IMV, including ventilator-associated pneumonia (VAP), diaphragmatic muscle atrophy, and barotrauma. Extubation failure, defined as the need for reintubation within 48-72 h after extubation, occurs in approximately 10-15% of patients reaching 20% in high-risk patients including factors of age \>65 years, chronic cardiac or respiratory disease, IMV duration \>7 days. Extubation failure is associated with substantial morbidity and mortality, with reported hospital mortality rates up to 25-50%, as well as prolonged ICU length of stay and increased healthcare costs. Modern ventilators provide simple, non-invasive access to two complementary physiological indices: the airway occlusion pressure at 100 ms (P0.1), a surrogate of central respiratory drive, and the change in inspiratory pressure during an occlusion maneuver (ΔPocc), a marker of the overall inspiratory effort. This study assesses the predictive value of P0.1 and ΔPocc measured before and during an SBT for predicting reintubation within 3 days after extubation.
Interventions
None listed
Sponsors
Rennes University Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adult patients meeting all the weaning criteria set out in the consensus of the International Conference on Weaning: * Duration of mechanical ventilation prior to the first weaning trial \> 24 hours * Respiratory rate ≤ 35 breaths/min, * Adequate oxygenation defined as SpO₂ ≥ 90% with FiO₂ ≤ 0.4 or PaO₂/FiO₂ ≥ 150 mm Hg with PEEP ≤ 8 cmH₂O, * Adequate cough reflex, * A conscious patient who is responsive to commands and has a RASS (Richmond Agitation Sedation Scale) score between +1 and -2 * Haemodynamically stable without vasopressors or on a minimal dose (noradrenaline \<0.1 µg/kg/min) * Patient informed about the study and expressing no objection to participating
Exclusion criteria
* Patients with neurological injury and a Glasgow Motor Score of ≤ M5 * Decision not to reintubate in the event of extubation failure * Adults subject to legal protection (judicial protection, curatorship, guardianship), and persons deprived of their liberty
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reintubation rate within 3 days after extubation | 3 days following extubation | Number of patients requiring reintubation within 3 days following extubation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ICU mortality | From ICU admission to ICU discharge or death, assessed up to 60 days | Number of patients who died during the stay in ICU |
| ICU length of stay | Between admission to and discharge from the ICU, assessed up to 60 days | the length of time between admission to and discharge from the intensive care unit |
| Hospital length of stay | From ICU admission to hospital discharge, assessed up to 90 days | The length of time between admission to the ICU and discharge from the hospital |
| Reintubation rate within 2 days after extubation | 2 days following extubation | Number of patients requiring reintubation within 2 days following extubation |
| Reintubation rate within 7 days after extubation | 7 days following extubation | Number of patients requiring reintubation within 7 days following extubation |
Countries
France
Outcome results
None listed