Difficult-to-wean Adult Patients Clinical Trial
Official title:
Daily Lung Ultrasound Assisting Weaning From Mechanical Ventilation in Difficult-to-wean Adult Patients - a Randomized Trial.
Daily lung ultrasound can help weaning from mechanical ventilation in difficult-to-wean adult patients. In this randomized trial, standardized lung ultrasound will be performed daily asssociated with standardized interventions aiming to decrease the total time in mechanical ventilation.
This trial will be performed in two intensive care units (ICUs). After randomization, all
patients in the intervention group will undergo daily lung ultrasounds before the next
spontaneous breathing trial. The results from the lung ultrasound will indicate specific
interventions to facilitate weaning:
- No sign of lung sliding (ultrasound finding suggestive of pleural movement): prompt
evaluation for pneumothorax or mainstream intubation will be indicated;
- normal lung ultrasound (ultrasound A profile): the patient will be evaluated for deep
vein thrombosis / pulmonary embolism and/or for reversible airway obstruction (e.g.
uncontrolled asthma or COPD [Chronic Obstructive Pulmonary Disease] exacerbation)-
followed by appropriate treatment. If the patient has COPD, non invasive mechanical
ventilation must be used as mode of discontinuing mechanical ventilation;
- lung ultrasound shows pulmonary edema (ultrasound B profile): cardiogenic pulmonary
edema will be differentiated from acute Respiratory Distress Syndrome (ARDS) - followed
by appropriate treatment (e.g. a negative fluid balance of, at least, 1000 ml before
the next spontaneous breathing trial);
- lung ultrasound shows asymmetrical patterns (ultrasound AB profile or Pulmonary
Consolidation): the possibility of an uncontrolled infection will be investigated;
- presence of simple pleural effusion: diuretics will be indicated (for a negative fluid
balance of, at least, 1000 ml before the next spontaneous breathing trial) or
thoracocentesis at description of the assistant team;
- presence of complex pleural effusion: other image exam will be performed, and will be
evaluated by the surgical team.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care