Stroke Clinical Trial
Official title:
Duration of Mechanical Ventilation and Mortality Among Brain-injured Patients - a Before-after Evaluation of a Quality Improvement Project
Protective ventilation (association of a tidal volume < 8 ml/kg with a positive end
expiratory pressure) is poorly used in severe brain-injured patients. Moreover, a systematic
approach to extubation may decrease the rate of extubation failure and enhance outcomes of
brain-injured patients.
We hypothesized that medical education and implementation of an evidence-base care bundle
associating protective ventilation and systemic approach to extubation can reduce the
duration of mechanical ventilation in brain-injured patients.
A before/after study design will be used. The before period (control phase) will consisted
of all consecutive patients with severe brain-injury who were admitted to the participating
ICUs.
During the interphase, all physicians, residents, physiotherapists and nurses will receive a
formal training for the processes and procedures related to the 2 point bundle: protective
ventilation and systematic approach to extubation (according to recommendation for the use
of tidal volume < 7 ml/kg and of a positive expiratory pressure = 6 to 8 cmH20 (centimeter
of water) and extubation as soon as ventilatory weaning is associated with a glasgow coma
scale equal or above 10 and cought).
The after period consisted of all consecutive severe brain-injured patients admitted to the
participating ICUs after the formal training.
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Observational Model: Case Control, Time Perspective: Prospective
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