Clinical Trials Logo

Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05000034
Other study ID # PO20147
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date February 2, 2021
Est. completion date August 2, 2024

Study information

Verified date August 2023
Source CHU de Reims
Contact Antoine GOURY
Phone 03 10 73 68 85
Email agoury@chu-reims.fr
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Background: Prolonged mechanical ventilation (MV) exposes patients to increased risk of infection and mortality. A weaning protocol (WP) reduces the duration of MV. However, these protocols remain complicated to implement in clinical practice. These considerations led to the development of automated weaning systems (AWS) which are expensive and limited to expert centers. Scope of the problem: AWS are not yet the standard care because evidence of AWS benefit is weak and several unanswered questions remain regarding their roles in weaning. There is a need for building new ways to improve WP. Indeed, medical staff's compliance with a daily screening of patients to wean is low. Moreover, modifications in ventilator settings require the availability of physicians at bedside and are rarely modified on a daily basis. This leads to impaired weaning process and prolonged MV for patients. Acknowledge gap: Capnography (CAP) has been validated for intubation procedures and integrated into AWS. Some studies encouraging use of CAP have shown an optimization of MV, a decrease of unnecessary arterial blood gas without impacting patients' prognosis. However, the role of CAP in WP in intensive care units (ICU) has not been assessed so far. Hypothesis: A nurse driven WP based on CAP may improve accuracy of weaning procedures at bedside. Such protocol might be easy to apply in daily practice and could reduce both the duration of MV and its related complications. Methods: This is a prospective, bi-center, pilot study to assess the feasibility of a new nurses managed WP based on capnography among patients requiring more of 48 hours of MV. Enrollment of 100 consecutive patients in two ICU of the universitary hospital in Reims. The primary endpoint is the protocol compliance. Secondary endpoints are: capacity to performed a weaning (time to first extubation, total duration of MV...) caregivers' acceptance and feelings regarding the protocol, a safety evaluation with report of hospital mortality, ventilator associated-pneumonia, autoextubation, length of stay and the number of ABG/patient/day during the study period. Inclusion critera: all patients on MV for more than 48 hours and stabilization of the ICU entry pathology. Exclusion critera: Patients with severe neuropathy, cardiopathy or pulmonary disease. Weaning protocol begins when the following criteria are present: PEEP ≤ 8 cmH2O, PaO2/FiO2 ratio ≥150 (mmHg) or SaO2 ≥ 90% with FiO2 ≤ 0.5. The final criterion for study entry is successful completion of a 30-min spontaneous breathing test (SBT) using pressure support (PS) (max 30 cmH2O). After a successful test, nurse reduces PS by 2 mmHg every 3 hours and the FIO2 as long as the patient remains in his comfort zone defined as: FR 12-30/min, VT ≥ 6ml/kg and ETCO2 ≤ 55 mmHg (≤65 mmHg for chronic obstructive pulmonary disease (COPD) patients). A scale allows FIO2 and PEEP to be titrated with an oxygen saturation between 90% and 98% (92% for COPD). Nurses recorded every 3 hours ventilatory, hemodynamic, sedation parameters and modifications. At any time physicians can return to the previous settings if the patient is leaving the comfort zone. SBT are conducted when a minimum level of PS and PEEP is reached, 7cmH20 and 5cmH20 respectively. SBT performed using a T piece with or no oxygen for 30-120 min. If a patient passes a successful SBT and meets extubation criteria, he is extubed. Extubation and SBT protocols are performed according to French guidelines SFAR/SRLF. Nevertheless, extubation always remains the decision of the attending physician. Protocols continue until successful extubation (at least 48 hours of unassisted spontaneous breathing), ICU death, ICU discharge or until day 90 after randomization. Interests and Scientific impacts: For patients, a potential reduction of VM duration and its associated-complications. For caregivers, a more efficient WP and a better optimization of workload. This pilot study will be a step before to investigate larger studies to compare our WP to standard care.


Recruitment information / eligibility

Status Recruiting
Enrollment 50
Est. completion date August 2, 2024
Est. primary completion date May 2, 2024
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility inclusion criteria : - patients aged over 18 years and admitted in intensive care - invasive ventilation with assisted mode (assist-control or spontaneous with pressure support) for more than 48 hours, - stabilization of the cause of admission defined as: positive end-expiratory pressure level lower than or equal to 8 cm of water, a arterial oxygen saturation higher than 90 percent with a fraction of inspired oxygen lower than or equal to 50 percent for acute respiratory failure; infusions of norepinephrine less than or equal to 0,2 gamma/kg/min, no epinephrine or dobutamine for cardiogenic or septic shock; body temperature 36-38,5°C. exclusion criteria : - schedulded extubation within 24 hours after the inclusion, - schedulded surgery within week after the inclusion, - no available capnometer, - end stage chronic disease (cardiac, pulmonary, or renal), - "do not resuscitate order", - prior ventilation greater than 24 hours during the same hospitalization, - tracheostomy, - known or suspected severe myopathy or neuropathy, - severe chronic obstructive pulmonary disease, - pregnancy, - patients without medial care assistance. - conditions and/or circumstances that might result in difficulty to understand the informed consent

Study Design


Related Conditions & MeSH terms

  • Weaning From Mechanical Ventilation

Intervention

Procedure:
Weaning protocol
Application of a weaning protocol from the mechanical ventilation

Locations

Country Name City State
France Damien JOLLY Reims

Sponsors (1)

Lead Sponsor Collaborator
CHU de Reims

Country where clinical trial is conducted

France, 

Outcome

Type Measure Description Time frame Safety issue
Primary The primary endpoint is the protocol compliance We will measure the percentage of hours with WP violation for each patient included. WP violation is defined as unauthorized use of other MV mode than pressure support (PS), absence of PS level modification or return to previous settings while patient is in his "comfort zone", failure to follow the FIO2/PEEP titration chart At the end of the procedure for each included patient
Secondary Nurses' acceptance and feelings regarding the protocol Acceptance and feelings regarding the protocol evaluated using a visual analogue scale (VAS) At the end of the procedure for each included patient
Secondary Physicians' acceptance and feelings regarding the protocol Acceptance and feelings regarding the protocol evaluated using a visual analogue scale (VAS) At the end of the procedure for each included patient
Secondary Safety evaluation Report the number of physician's interventions, mortality rate, extubation failures, ventilator associated-pneumonia At the end of the procedure for each included patient
See also
  Status Clinical Trial Phase
Recruiting NCT05012696 - Physiological Effects of Non-invasive Mechanical Ventilation Versus High-flow Nasal Cannula in Critically Ill Patients at High Risk of Extubation Failure N/A
Recruiting NCT04792788 - NAVA vs PSV Ventilation During Weaning From Mechanical Ventilation in Children After Liver Transplantation N/A
Completed NCT02855619 - Comparison of the Impact of Three Programs of Inspiratory Muscles. N/A
Completed NCT03962322 - Diaphragmatic Tissue Doppler During Weaning From Mechanical Ventilation N/A
Completed NCT03140267 - Assessment of Inspiratory Muscles Strength and Endurance Evolution on Difficult to Wean Patients in Intensive Care Unit N/A
Recruiting NCT03018483 - Mechanical Ventilation- Weaning and Thoracic Impedance Tomography N/A
Completed NCT01666054 - Comparison of Weaning on Pressure Support vs. Proportional Assist Ventilation: A Pilot Study N/A
Recruiting NCT06465082 - Diaphragmatic Thickening Fraction as a Predictor of Successful Weaning
Recruiting NCT04779463 - Role of Ultrasound Assessment of Parasternal Intercostal Muscle Thickness During Weaning From Mechanical Ventilation
Recruiting NCT02361021 - Lung Aeration During WEANing From Mechanical Ventilation Determined by Electrical Impedance Tomography and Lung Ultrasound N/A
Completed NCT04227639 - T-piece Versus Pressure-support for the Spontaneous Breathing Trial N/A
Not yet recruiting NCT04224246 - Impact of Gamma-OH on Sleep in ICU Patients Phase 2
Completed NCT01967108 - Post Extubation Chest Physiotherapy in ICU N/A