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Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol
INTRODUCTION: Readiness to be freed from ventilatory support can be evaluated by spontaneous breathing trial (SBT) assessing the patient’s ability to sustain respiratory effort after extubation. Current SBT practices are heterogenous and there are few physiological studies on the topic. The objectiv...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10347495/ https://www.ncbi.nlm.nih.gov/pubmed/37438068 http://dx.doi.org/10.1136/bmjopen-2022-070931 |
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author | Capdevila, Mathieu De Jong, Audrey Aarab, Yassir Vonarb, Aurelie Carr, Julie Molinari, Nicolas Capdevila, Xavier Brochard, Laurent Jaber, Samir |
author_facet | Capdevila, Mathieu De Jong, Audrey Aarab, Yassir Vonarb, Aurelie Carr, Julie Molinari, Nicolas Capdevila, Xavier Brochard, Laurent Jaber, Samir |
author_sort | Capdevila, Mathieu |
collection | PubMed |
description | INTRODUCTION: Readiness to be freed from ventilatory support can be evaluated by spontaneous breathing trial (SBT) assessing the patient’s ability to sustain respiratory effort after extubation. Current SBT practices are heterogenous and there are few physiological studies on the topic. The objective of this study is to assess which SBT best reproduces inspiratory effort to breathe after extubation depending on the patient’s illness. METHODS AND ANALYSIS: This will be a multicentre randomised cross-over physiological study, in a large population, in the era of modern intensive care units using last generation modern ventilators. Each included patient will perform three 15-minute SBTs in a random order: pressure support ventilation (PSV) level of 7 cmH(2)O with positive end expiratory pressure (PEEP) level of 0 cmH(2)O, PSV 0 cmH(2)O with PEEP 0 cmH(2)O and T-piece trial. A rest period of baseline state ventilation will be observed between the SBTs (10 min) and before extubation (30 min). Primary outcome will be the inspiratory muscle effort, reflected by pressure time product per minute (PTPmin). This will be calculated from oesophageal pressure measurements at baseline state, before and after each SBT and 20 min after extubation. Secondary outcomes will be PTPmin at 24 hours and 48 hours after extubation, changes in physiological variables and respiratory parameters at each step, postextubation respiratory management and the rate of successful extubation. One hundred patients with at least 24 hours of invasive mechanical ventilation will be analysed, divided into five categories of critical illness: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease and miscellaneous (pneumonia, sepsis, heart disease). ETHICS AND DISSEMINATION: The study project was approved by the appropriate ethics committee (2019-A01063-54, Comité de Protection des Personnes TOURS - Région Centre - Ouest 1, France). Informed consent is required, for all patients or surrogate in case of inability to give consent. TRIAL REGISTRATION NUMBER: NCT04222569. |
format | Online Article Text |
id | pubmed-10347495 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-103474952023-07-15 Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol Capdevila, Mathieu De Jong, Audrey Aarab, Yassir Vonarb, Aurelie Carr, Julie Molinari, Nicolas Capdevila, Xavier Brochard, Laurent Jaber, Samir BMJ Open Intensive Care INTRODUCTION: Readiness to be freed from ventilatory support can be evaluated by spontaneous breathing trial (SBT) assessing the patient’s ability to sustain respiratory effort after extubation. Current SBT practices are heterogenous and there are few physiological studies on the topic. The objective of this study is to assess which SBT best reproduces inspiratory effort to breathe after extubation depending on the patient’s illness. METHODS AND ANALYSIS: This will be a multicentre randomised cross-over physiological study, in a large population, in the era of modern intensive care units using last generation modern ventilators. Each included patient will perform three 15-minute SBTs in a random order: pressure support ventilation (PSV) level of 7 cmH(2)O with positive end expiratory pressure (PEEP) level of 0 cmH(2)O, PSV 0 cmH(2)O with PEEP 0 cmH(2)O and T-piece trial. A rest period of baseline state ventilation will be observed between the SBTs (10 min) and before extubation (30 min). Primary outcome will be the inspiratory muscle effort, reflected by pressure time product per minute (PTPmin). This will be calculated from oesophageal pressure measurements at baseline state, before and after each SBT and 20 min after extubation. Secondary outcomes will be PTPmin at 24 hours and 48 hours after extubation, changes in physiological variables and respiratory parameters at each step, postextubation respiratory management and the rate of successful extubation. One hundred patients with at least 24 hours of invasive mechanical ventilation will be analysed, divided into five categories of critical illness: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease and miscellaneous (pneumonia, sepsis, heart disease). ETHICS AND DISSEMINATION: The study project was approved by the appropriate ethics committee (2019-A01063-54, Comité de Protection des Personnes TOURS - Région Centre - Ouest 1, France). Informed consent is required, for all patients or surrogate in case of inability to give consent. TRIAL REGISTRATION NUMBER: NCT04222569. BMJ Publishing Group 2023-07-12 /pmc/articles/PMC10347495/ /pubmed/37438068 http://dx.doi.org/10.1136/bmjopen-2022-070931 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Intensive Care Capdevila, Mathieu De Jong, Audrey Aarab, Yassir Vonarb, Aurelie Carr, Julie Molinari, Nicolas Capdevila, Xavier Brochard, Laurent Jaber, Samir Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol |
title | Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol |
title_full | Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol |
title_fullStr | Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol |
title_full_unstemmed | Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol |
title_short | Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol |
title_sort | which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over global wean study protocol |
topic | Intensive Care |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10347495/ https://www.ncbi.nlm.nih.gov/pubmed/37438068 http://dx.doi.org/10.1136/bmjopen-2022-070931 |
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