Mechanical Ventilation Clinical Trial
Official title:
Work of Breathing Assessment During Weaning From Mechanical Ventilation
Introduction In patients assisted by mechanical ventilation, the Work Of Breathing (WOB) is
shared between the patient and the ventilator. During weaning from mechanical ventilation,
the WOB performed by the patient must be adequate and efficient to sustain spontaneous
ventilation after extubation. The monitoring of WOB during weaning might allow a better
management of the weaning process. Esophageal pressure (PES) is the reference technique to
measure WOB but alternate tools have been proposed. The main hypothesis is that Indirect
Calorimetry (IC) is valid to track the changes in energy expenditure due to the changes in
WOB in mechanically ventilated children during weaning from mechanical ventilation. The
primary objective of this study is to assess the validity of IC method for the WOB assessment
when compared to PES measurement and Electrical Activity of the diaphragm (EAdi) during a
spontaneous breathing trial (SBT) in continuous positive airway pressure, which is a routine
extubation readiness test which generally induces an increase in WOB.
Methods This is a prospective single center study. All intubated and mechanically ventilated
children >1 months and <18 years old, hospitalized in the pediatric intensive care unit will
be eligible.
Simultaneous recordings of Energy Expenditure, PES and EAdi will be performed during 3 steps:
before, during and after the SBT. Then outcome of patients will be collected.
The investigators plan to study a sample of 15 patients to be representative.
Relevance to the importance of child health in Canada The investigators expect that the
IC-based less invasive method will provide an accurate estimation of WOB assessment. Once
this tool is validated, the interest of IC to (i) early detect an increase in WOB during
mechanical ventilation in children, (ii) to assess the ability to extubate them and (iii) to
optimize nutritional support will be assessed in future studies.
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