Effect of lung volume preservation during spontaneous breathing trial on successful extubation in patients receiving mechanical ventilation: protocol for a multicenter clinical trial
Por:
Subirà, C, Rognoni, G, Baquerizo, H, Garcia, C, Cabanes, S, de la Torre, M, Quevedo, B, Pedros, C, Tizon, AI, Murillo, N, Parro, L, Eiras, F, Rialp, G, Altaba, S, Gonzalez-Castro, A, Pacheco, AF, Bayoumi, P, Gomez-Medrano, N, Vallverdu, I, Higon, A, Navarro, MD, Falcon, A, Keough, E, Arizo, D, Martinez, JF, Duran, N, Rodriguez, R, Popoviciu-Koborzan, MR, Guerrero, I, Concha, P, Barral, P, Batlle, M, Cano, S, Garcia-Castrillon, S, Andorra, X, Tua, Y, Arnau, A, Fernandez, R
Publicada:
16 jul 2024
Resumen:
BackgroundIn standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation.
MethodsThis multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization.
DiscussionWe aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients
Filiaciones:
Subirà, C:
Hosp Santa Creu & Sant Pau, Dept Resp Med, Barcelona, Spain
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid 28029, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
Rognoni, G:
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
Univ Vic, Univ Cent Catalunya UV UCC, Vic, Spain
Baquerizo, H:
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
Univ Vic, Univ Cent Catalunya UV UCC, Vic, Spain
Garcia, C:
Hosp Univ Canarias, Med Oncol, San Cristobal la Laguna, Tenerife, Spain
Cabanes, S:
Hosp Univ Araba Txagorritxu, Unidad Med Intens, Vitoria, Spain
de la Torre, M:
Hosp Mataro, Serv Med Intens, Mataro, Spain
Quevedo, B:
Hosp Clin Univ Valencia, Serv Med Intens, Valencia, Spain
Pedros, C:
Hosp Gen Granollers, Serv Med Interna, Unidad Cardiol, Granollers, Spain
Tizon, AI:
Complexo Hosp Univ Ourense, Serv Med Intens, Orense, Spain
Murillo, N:
Hosp Universitari Tarragona Joan XXIII, Serv Med Intens, Tarragona, Spain
Parro, L:
Hosp Univ Henares, Serv Med Intens, Coslada, Madrid, Spain
Eiras, F:
Complexo Hosp Univ Pontevedra, Serv Med Intens, Pontevedra, Spain
Rialp, G:
Hosp Son Llatzer, Serv Med Intens, Palma de Mallorca, Spain
Altaba, S:
Hosp Gen Univ Castello, Serv Med Intens, Castellon de La Plana, Spain
Gonzalez-Castro, A:
Hosp Univ Marques Valdecilla, Serv Med Intens, Santander, Spain
Pacheco, AF:
Hosp Universitari Vall dHebron, Serv Pediat Hematol, Barcelona, Spain
Bayoumi, P:
Hosp Gen Univ St Lucia, Serv Cardiol, Cartagena, Spain
Gomez-Medrano, N:
Hosp Gen Univ Elche, Serv Med Intens, Elche 03203, Spain
Vallverdu, I:
Hosp Univ St Joan de Reus, Serv Med Intens, Reus, Spain
Higon, A:
Hosp Gen Univ Morales Meseguer, Serv Med Interna, Murcia, Spain
Navarro, MD:
Hosp Arnau Vilanova, Serv Med Intens, Valencia, Spain
Falcon, A:
Hosp Mutua Terrassa, Serv Endocrinol, Terrassa, Spain
Keough, E:
Hosp Univ Princesa, Serv Med Intens, Madrid, Spain
Arizo, D:
Hosp Sagunto, Serv Med Intens, Sagunto, Spain
Martinez, JF:
Hosp Reg Univ Malaga, Serv Med Intens, Malaga, Spain
Duran, N:
Hosp Univ Sagrat Cor, Serv Med Intens, Barcelona, Spain
Rodriguez, R:
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid 28029, Spain
Hosp Univ Cent Asturias, Serv Med Intens, Oviedo, Spain
Inst Invest Sanitaria Principado Asturias, Oviedo, Spain
Popoviciu-Koborzan, MR:
Hosp St Joan Despi Moises Broggi, Oncol, Sant Joan Despi, Spain
Guerrero, I:
Hosp Univ Virgen Nieves, Serv Med Intens, Granada, Spain
Concha, P:
Hosp Verge Cinta, Serv Med Intens, Tarragona, Spain
Barral, P:
Complejo Hosp Univ Santiago de Compostela, Serv Med Intens, Santiago De Compostela, Spain
Batlle, M:
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid 28029, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
Cano, S:
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
Garcia-Castrillon, S:
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
Andorra, X:
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
Tua, Y:
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
Arnau, A:
Xarxa Assistencial Fundacio Althaia, Manresa, Spain
Univ Cent Catalunya, Vic, Spain
Univ Vic Cent Univ Catalonia UV UCC, Fac Med, Vic, Spain
Fernandez, R:
Inst Recerca Biomed Catalunya Cent IRIS CC, Grp Recerca Malalt Crit GMC, Vic, Spain
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid 28029, Spain
Althaia Xarxa Assistencial Univ, Serv Med Intens, Manresa, Spain
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