Acute Respiratory Insufficiency Clinical Trial
Official title:
Comparison of Two Ventilatory Modes During Spontaneous Breathing Trial in Intubated Patients
Patients who are intubated and mechanically ventilated for acute respiratory failure in the
Intensive Care Unit (ICU) are at some point eligible for weaning. The common way to wean them
from mechanical ventilation is to screen criteria for feasibility and, if present, to test
feasibility by performing spontaneous breathing trial. This latter can be done either by
setting a low pressure support level (expected to compensate the airflow resistance due to
endotracheal tube) or by allowing the patient to breathe spontaneously through the tube
without any support from the ventilator. Combination of low pressure assistance strategy (7
cm H2O) and positive expiratory pressure (PEP) of 4 cm H2O is the strategy used in our unit.
Such a low pressure support level should actually result in a real assistance and, hence this
is not the real spontaneous breathing capacity that is tested. Some ICU ventilators offer the
option of compensating for the airflow resistance due to endotracheal tube, automatic tube
compensation (ATC). Therefore, investigators aimed at comparing in patients ready to wean the
usual procedure in our ICU and the ATC mode. In the ATC arm, the patients are breathing
spontaneously through the endotracheal tube and are connected to the ventilator set at
inspiratory pressure support of 0 cm H2O, PEP 4 cm H2O and ATC on.
Two parallel arms depending on the order of allocation of each mode: pressure support 7 cm
H2O + PEP 4 cm H2O then ATC or the opposite. The primary endpoint is the power of the work of
breathing. The hypothesis is that the power of the work of breathing is greater in ATC than
in the usual procedure, and hence this latter is a real ventilator support.
n/a
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