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ID
Source
Brief title
Health condition
Prolonged mechanical ventilation, muscle weakness, weaning, weaning failure
Sponsors and support
Intervention
Outcome measures
Primary outcome
Weaning duration
Secondary outcome
ICU stay, hospital stay
Background summary
Approximately 30% of the patients receiving mechanical ventilation (MV) in intensive care units (ICUs) for more than two days have difficulties weaning, which is directly related to both serious complications of invasive MV, and poorer patient outcomes. The development of early prognostic factors that acknowledge the complexity of weaning failure might help to address this problem. However, the currently available parameters show no more than modest accuracies in predicting weaning outcomes. To address this problem, we propose an approach that takes the dynamically changing condition of ventilated patients into account; 1) acquire physiological data over the entire MV period in order to detect trends in patient status over time, and 2) use more state-of-the-art data analysis methods, preserving more context in the data and outcomes. Applied to the concept of breathing effort we propose to study the interactions between the physiological systems involved in the breathing; the neural respiratory drive and innervation, the respiratory muscle dynamics, and the respiratory system mechanics. This approach might provide more insight in the pathophysiological processes going on in a patient, and can thus be used to guide MV management decisions throughout the entire weaning process.
The primary objective of this study is to investigate the relation between, on the one hand, 1) the balance between the respiratory system mechanics and muscle dynamics, and 2) the balance between the pressure support level and respiratory drive, and, on the other hand, the weaning duration in patients receiving prolonged mechanical ventilation.
Second, the effect of ventilatory support settings with respect to the optima in these physiological relations on the weaning duration, and the progression of these relations over the weaning duration are studied. Besides, the relations of various weaning strategies and aids (e.g. nasal high flow therapy, and inspiratory muscle training) with the course of the respiratory function are investigated.
Study objective
Difficult to wean patients have a mismatch between optimal mechanical ventilation settings lung mechanics and respiratory muscle dynamics
Study design
Every other day from initiation of supported mechanical ventilation to successful weaning
Intervention
PEEP trials, PS trials, surface respiratory muscle EMG, airway occlusion pressures
Inclusion criteria
1. Informed consent,
2. aged 18 years or older,
3. receiving or expected to receive invasive MV for >48h,
4. ventilated in pressure support mode,
5. SpO2 ≥ 90% (13),
6. FiO2 ≤ 60% (13),
7. 0 ≥ Richmond Agitation Sedation Scale (RASS-score) ≥ -4
Exclusion criteria
1. a medical history of neurological disease that might affect the respiratory drive or neural conduction,
2. BMI > 30 kg/m²,
3. pregnant,
4. moribund,
5. persistent pneumothorax.
Design
Recruitment
IPD sharing statement
Followed up by the following (possibly more current) registration
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
NTR-new | NL9654 |
CCMO | NL75951.091.21 |
OMON | NL-OMON51035 |