Ventilator Weaning Clinical Trial
Official title:
Postextubation High-flow Nasal Cannula Versus Standard Oxygen Therapy in Critically Ill Patients: a Physiologic Randomized Crossover Study
High-flow nasal cannula (HFNC) is a rather novel system to provide oxygen therapy, which provides flows up to 60 liters/minute (LPM) of heated and humidified gas through nasal prongs. HFNC is increasingly being used in patients with acute respiratory failure. In healthy volunteers and in patients with acute respiratory failure it has been shown to induce several effects beyond those expected for a standard oxygen therapy, such as increased carbon dioxide (CO2) clearance and positive airway pressure. One of the potential indications for HFNC is to facilitate weaning from mechanical ventilation and extubation. As weaning failure is one of the most complex challenges in mechanically ventilated patients, the use of HFNC after extubation, in order to prevent reintubation, has been evaluated in some clinical trials, with promising results. However, the role of HFNC postextubation is still controversial, and information regarding its effects on the pathophysiologic mechanisms of weaning failure is lacking. The goal of this proposal is to compare the acute physiologic effects of postextubation HFNC versus standard oxygen therapy, in critically ill patients, on relevant mechanisms related to weaning failure: work of breathing, lung function, systemic hemodynamics. This will be a randomized crossover study which will include critically ill mechanically ventilated patients, who fulfill criteria indicating they may be ready for weaning from mechanical ventilation, and in whom a spontaneous breathing trial (SBT) is planned to determine if they should be extubated. After checking eligibility and obtaining informed consent, patients will be monitored with an esophageal catheter (esophageal / gastric pressures to determine work of breathing, and electric activity of diaphragm to determine neuromechanical coupling), and a noninvasive ventilation monitor (electric impedance tomography to assess global and regional ventilation). Work of breathing, lung function, and systemic hemodynamics will be assessed during the SBT. Inclusion in the study will be confirmed only if they pass the SBT and are extubated. During the first 2 hours after extubation patients will undergo one hour of HFNC and one hour of standard oxygen therapy, with the crossover sequence being randomized previously at the time of inclusion, and with assessments repeated at the end of each treatment period.
n/a
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT02894177 -
Transcutaneous Carbon Dioxide Pressure (tcPCO2) Monitoring for the Prediction of Extubation Failure in the ICU
|
N/A | |
Recruiting |
NCT05114551 -
ICU Predictive Score of WEaning Success in Patients At Risk of Extubation Failure
|
||
Completed |
NCT04011852 -
The Role of Chest Electrical Impedance Tomography in the Pediatric Ventilator Weaning
|
||
Recruiting |
NCT02921334 -
Early Tracheotomy for Switching Between Invasive and Noninvasive Ventilation to Facilitate Weaning
|
N/A | |
Recruiting |
NCT02921347 -
Switching Between Invasive and Noninvasive Ventilation to Facilitate Weaning in Difficult-weaning Patients
|
N/A | |
Recruiting |
NCT06055413 -
Home-based Optimization of Mechanical Ventilation in Children
|
N/A | |
Active, not recruiting |
NCT04023643 -
Pediatric Ventilation Weaning
|
N/A | |
Completed |
NCT05254691 -
WOB and Paediatric Mechanical Ventilation
|
N/A | |
Recruiting |
NCT05999526 -
Mechanical Ventilation Reconnection for One Hour After Spontaneous Breathing Trial
|
N/A | |
Active, not recruiting |
NCT02820090 -
The Predictive Effect of the Inflammatory Response on the Evacuation of Mechanical Ventilation and the Mechanism
|
N/A | |
Recruiting |
NCT01131377 -
Acetazolamide Facilitates Ventilator Weaning
|
N/A | |
Completed |
NCT02412202 -
Echocardiographic Detection of Extravascular Lung Water Increase During Weaning From Mechanical Ventilation
|
N/A | |
Completed |
NCT00445289 -
Automatic Control of Pressure Support Ventilation in Surgical Intensive Care Units
|
N/A | |
Recruiting |
NCT05380687 -
Time Course of Neuro-ventilatory Efficiency During a Spontaneous Breathing Training
|
N/A | |
Terminated |
NCT01535755 -
A Protocol to Wean From Noninvasive Mechanical Ventilation
|
N/A | |
Completed |
NCT03433105 -
Oxygen Uptake in Weaning of Patients From Prolonged Mechanical Ventilation
|
||
Completed |
NCT00505804 -
A Comparison of Dexmedetomidine and Haloperidol in Patients With Intensive Care Unit (ICU)-Associated Agitation and Delirium
|
Phase 2 | |
Completed |
NCT02946502 -
Handgrip Strength Value in Predicting Mechanical Ventilation Weaning
|
N/A | |
Completed |
NCT03673683 -
Sedation and Weaning in Children Requiring Invasive Mechanical Ventilation
|
N/A | |
Terminated |
NCT03019107 -
Breath Synchronized Abdominal Muscle Stimulation to Facilitate Ventilator Weaning: a Pilot Study
|