Removal of ventilator tube from patients in Neuro ICU and need for replacement : Prospective Study

Recruiting

Registration Number: CTRI/2023/02/049570

Lead Sponsor: NIMHANS

Brief Summary: Patients admitted to the Neuro Intensive Care Unit (NICU) may require intubation and mechanical ventilation because of the respiratory compromise from either central or peripheral neurological pathology. Liberation from invasive ventilation, that is, extubation, at the earliest possible time is a widely accepted principle in intensive care for reduced morbidity and better outcomes. For this, classic extubation criteria have been established in the general critical care setting, mainly targeting pulmonary function and cooperativeness of the patient. However, classic extubation criteria have failed to predict successful extubation in many studies on NICU patients. Both delayed and premature extubation increase the rates of complications, need for tracheotomy, and duration of intensive care unit (ICU) stay, morbidity and mortality. Thus, it is crucial to predict whether and when to extubate such patients. The decision to extubate a neuro critical care patient with residual impaired consciousness has a high degree of uncertainty of success and undesirability of incorrect prediction. The incidence of extubation failure in general ICU varies between 6 and 47%. The incidence of extubation failure in neuro critical care patients is around 19%. The definition of extubation failure varies substantially between studies from 48 hours to 7 days. Recently it has been proposed to extend the timeframe that captures > 90% of extubation failure. Based on this pragmatic approach, a 5-day time frame was selected to account for >90% of failure. Therefore, extubation failure is defined as the need for re-intubation within 5 days of the extubation. Parameters used to predict extubation failure can be categorized into parameters assessing respiratory mechanics, airway patency and protection and cardiovascular reserve and neurological factors. There is limited data available on the incidence of extubation failure in neuro ICU patients in our country, hence this study is intended to assess the incidence of extubation failure in neuro critical care patients, the risk factors and the outcomes associated with it.

Detailed Description: Not available

Recruitment & Eligibility

Status: Open to Recruitment

Sex: All

Target Recruitment: 1500

Inclusion Criteria

Inclusion criteria includes all patients getting admitted to Neuro ICUs and on endotracheal tube at any point in Neuro ICUs.

Exclusion Criteria

Patients who are tracheostomised before coming into Neuro ICUs 2.
Refusal of consent to participate in the study.

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Incidence of Extubation failure in patients admitted in Neuro ICUs	DAY 1 AFTER EXTUBATION \| DAY 2 AFTER EXTUBATION \| DAY 3 AFTER EXTUBATION \| DAY 4 AFTER EXTUBATION \| DAY 5 AFTER EXTUBATION

Secondary Outcome Measures

Name	Time	Method
To assess risk factors associated with Extubation failure	1. DAY OF ADMISSION IN ICU
To assess impact of Extubation failure on patient outcome in terms of	1. Duration of ICU and Hospital stay

Trial Locations

Locations (1): NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES
🇮🇳
Bangalore, KARNATAKA, India
NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES
🇮🇳Bangalore, KARNATAKA, India
RAKULPRASATH S
Principal investigator
9942173629
rakulprasath@gmail.com