The PROMIZING trial enrollment algorithm for early identification of patients ready for unassisted breathing
Brault, Clément (Amiens-Picardie University Hospital)
Mancebo, Jordi (Institut d'Investigació Biomèdica Sant Pau)
Suárez Montero, Juan Carlos (Institut d'Investigació Biomèdica Sant Pau)
Bentall, Tracey (University of Toronto)
Burns, Karen E.A. (St. Michael's Hospital)
Piraino, Thomas (St. Michael's Hospital)
Lellouche, François (Institut Universitaire de Cardiologie Et de Pneumologie de Québec)
Bouchard, Pierre-Alexandre (Institut Universitaire de Cardiologie Et de Pneumologie de Québec)
Charbonney, Emmanuel (Centre de Recherche du CIUSSS NIM)
Carteaux, Guillaume (Institut Mondor de Recherche Biomédicale)
Maraffi, Tommaso (Centre Hospitalier Intercommunal de Créteil)
Beduneau, Gaëtan (Normandie University)
Mercat, Alain (CHU D'Angers)
Skrobik, Yoanna (Opus Clinic)
Zuo, Fei (St. Michael's Hospital)
Lafreniere-Roula, Myriam (Li Ka Shing Knowledge Institute of St. Michael's Hospital)
Thorpe, Kevin (University of Toronto and Applied Health Research Centre)
Brochard, Laurent (University of Toronto)
Bosma, Karen J. (University of Western Ontario)
Universitat Autònoma de Barcelona

Fecha:	2022
Resumen:	Background: Liberating patients from mechanical ventilation (MV) requires a systematic approach. In the context of a clinical trial, we developed a simple algorithm to identify patients who tolerate assisted ventilation but still require ongoing MV to be randomized. We report on the use of this algorithm to screen potential trial participants for enrollment and subsequent randomization in the Proportional Assist Ventilation for Minimizing the Duration of MV (PROMIZING) study. Methods: The algorithm included five steps: enrollment criteria, pressure support ventilation (PSV) tolerance trial, weaning criteria, continuous positive airway pressure (CPAP) tolerance trial (0 cmHO during 2 min) and spontaneous breathing trial (SBT): on fraction of inspired oxygen (FO) 40% for 30-120 min. Patients who failed the weaning criteria, CPAP Zero trial, or SBT were randomized. We describe the characteristics of patients who were initially enrolled, but passed all steps in the algorithm and consequently were not randomized. Results: Among the 374 enrolled patients, 93 (25%) patients passed all five steps. At time of enrollment, most patients were on PSV (87%) with a mean (± standard deviation) FO of 34 (± 6) %, PSV of 8. 7 (± 2. 9) cmHO, and positive end-expiratory pressure of 6. 1 (± 1. 6) cmHO. Minute ventilation was 9. 0 (± 3. 1) L/min with a respiratory rate of 17. 4 (± 4. 4) breaths/min. Patients were liberated from MV with a median [interquartile range] delay between initial screening and extubation of 5 [1-49] hours. Only 7 (8%) patients required reintubation. Conclusion: The trial algorithm permitted identification of 93 (25%) patients who were ready to extubate, while their clinicians predicted a duration of ventilation higher than 24 h.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Critical care ; Extubation ; Mechanical ventilation ; Respiratory mechanics ; Ventilator weaning
Publicado en:	Critical care, Vol. 26 Núm. 1 (december 2022) , p. 188, ISSN 1466-609X

DOI: 10.1186/s13054-022-04063-4
PMID: 35739553

9 p, 901.7 KB

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