Effect of lung volume preservation during spontaneous breathing trial on successful extubation in patients receiving mechanical ventilation : protocol for a multicenter clinical trial
Subirà, Carles (Institut de Recerca Sant Pau)
Rognoni, Gina (Universitat de Vic- Universitat Central de Catalunya (UVIC-UCC))
Baquerizo, Herbert (Universitat de Vic- Universitat Central de Catalunya (UVIC-UCC))
García, Carolina (Hospital Universitario de Canarias (La Laguna))
Cabañes, Sara (Txagorritxu Hospital Universitario Araba)
de la Torre, Maria (Hospital de Mataró. Consorci Sanitari del Maresme)
Quevedo, Beatriz (Hospital Clínic Universitari (València))
Pedrós, Cristina (Hospital General de Granollers)
Tizón, Ana I. (Complexo Hospitalario Universitario de Ourense - CHUO)
Murillo, Natalia (Hospital Universitari Joan XXIII de Tarragona)
Parro, Laura (Hospital Universitario del Henrares)
Eiras, Fernando (Hospital Universitario de Pontevedra)
Rialp, Gemma (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Altaba, Susana (Hospital General Universitario de Castellón)
González-Castro, Alejandro (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Pacheco, Andrés (Hospital Universitari Vall d'Hebron)
Bayoumi, Pablo (Hospital General Universitario Santa Lucía (Cartagena, Múrcia))
Gómez-Medrano, Norma (Hospital General Universitario de Elche)
Vallverdú, Imma (Hospital Universitari Sant Joan de Reus (Tarragona))
Higón, Áurea (Hospital General Universitario Morales Meseguer (Múrcia))
Navarro, María D. (Hospital Arnau de Vilanova (València))
Falcón, Alirio (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Keough, Elena (Hospital Universitario de la Princesa (Madrid))
Arizo, David (Hospital de Sagunto)
Martínez, Juan F. (Hospital Regional Universitario de Málaga)
Durán, Núria (Hospital del Sagrat Cor (Barcelona, Catalunya))
Rodríguez, Raquel (Instituto de Investigación Sanitaria del Principado de Asturias)
Popoviciu-Koborzan, Melinda R. (Hospital de Sant Joan Despí Moisès Broggi)
Guerrero, Isabel (Hospital Universitario Virgen de las Nieves (Granada))
Concha, Pablo (Hospital de Tortosa Verge de la Cinta)
Barral, Patricia (Complejo Hospitalario Universitario de Santiago de Compostela)
Batlle, Montserrat (Althaia Xarxa Assistencial Universitària de Manresa)
Cano, Sílvia (Althaia Xarxa Assistencial Universitària de Manresa)
Garcia-Castrillon, Silvia (Althaia Xarxa Assistencial Universitària de Manresa)
Andorrà, Xavier (Althaia Xarxa Assistencial Universitària de Manresa)
Tua, Yenifher (Althaia Xarxa Assistencial Universitària de Manresa)
Arnau, Anna (Universitat de Vic-Central de Catalunya (UVIC-UCC))
Fernández, Rafael (Althaia Xarxa Assistencial Universitària de Manresa)
Universitat Autònoma de Barcelona

Date:	2024
Abstract:	Background: In standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmHO pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation. Methods: This multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmHO PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization. Discussion: We aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients. Trial registration: The Research Ethics Committee (CEIm) of the Fundació Unió Catalana d'Hospitals approved the study (CEI 22/67 and 23/26). Registered at ClinicalTrials. gov in August 2023. Identifier: NCT05526053.
Rights:	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.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Extubation ; Lung ultrasound ; Mechanical ventilation ; Spontaneous breathing trial ; Weaning
Published in:	Trials, Vol. 25 Núm. 1 (december 2024) , p. 481, ISSN 1745-6215

DOI: 10.1186/s13063-024-08297-1
PMID: 39014430

12 p, 1.1 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles