respiratory failure respiratory support
Conditions
Interventions
Before extubation, patients are randomized to receive conventional oxygen
(reference group) or HFNO as oxygenation regimen after extubation.
Both groups will undergo several minimally invasive measu
Sponsors
Erasmus MC, Universitair Medisch Centrum Rotterdam
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: - Aged >= 18 years - Receiving invasive mechanical ventilation >48 hours for any cause - Scheduled for extubation as per local clinical guideline - Provided informed consent
Exclusion criteria
Exclusion criteria: - Any clinical situation preventing appropriate execution of study procedures, such as; o Severe agitated delirium o Do not reintubate order - The presence of a tracheostomy - Respiratory acidosis, defined as a pH 6.5 kPa / PCO2 > 50 mmHg) during or after SBT - Any feature that prohibits HFNO-initiation o Recent facial upper-airway surgery o Anatomic abnormalities that preclude appropriate fitting of HFNO cannula o Current exacerbation of obstructive pulmonary disease - Obstructive/central Sleep Apnoea Syndrome or Obesity Hypoventilation Syndrome in medical history - Contra-indication for nasogastric tube or inability to perform adequate PES measurements, e.g.: o Recent esophageal surgery o Prior esophagectomy o Known presence of esophageal varices o Severe bleeding disorders - Known diaphragm paralysis defined as elevated hemi-diaphragm on X-ray or evidence of paralysis during ultrasound (i.e. paradoxal diaphragm movement during sniffing) - Known pregnancy or current breast-feeding
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The main outcome is the difference in change in lung respiratory muscle effort (mean ΔPES) at 24 hours post-extubation between the study groups. | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary parameters are differences in changes in respiratory effort at 2 and 4 hours post-extubation, difference in change in lung aeration (mean ΔEELI), differences in tidal volume, Lung Ultrasound (LUS) score, dyspnea score, and respiratory and sputum parameters between patients undergoing different post-extubation oxygenation regimens. | — |
Countries
Netherlands
Outcome results
None listed