Duration of Mechanical Ventilation and Mortality Among Brain-injured Patients - a Before-after Evaluation of a Quality Improvement Project
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 560
- 试验地点
- 21
- 主要终点
- Mechanical ventilatory free days
研究概览
简要总结
Protective ventilation (association of a tidal volume < 8 ml/kg with a positive end expiratory pressure) is poorly used in severe brain-injured patients. Moreover, a systematic approach to extubation may decrease the rate of extubation failure and enhance outcomes of brain-injured patients.
We hypothesized that medical education and implementation of an evidence-base care bundle associating protective ventilation and systemic approach to extubation can reduce the duration of mechanical ventilation in brain-injured patients.
详细描述
A before/after study design will be used. The before period (control phase) will consisted of all consecutive patients with severe brain-injury who were admitted to the participating ICUs.
During the interphase, all physicians, residents, physiotherapists and nurses will receive a formal training for the processes and procedures related to the 2 point bundle: protective ventilation and systematic approach to extubation (according to recommendation for the use of tidal volume < 7 ml/kg and of a positive expiratory pressure = 6 to 8 cmH20 (centimeter of water) and extubation as soon as ventilatory weaning is associated with a glasgow coma scale equal or above 10 and cought).
The after period consisted of all consecutive severe brain-injured patients admitted to the participating ICUs after the formal training.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients (traumatic brain-injured, subarachnoid hemorrhage, stroke or other)
- •Brain injury (Glasgow Coma Scale ≤ 12 associated with at least one anomaly related to an acute process on head tomographic tomodensitometry
- •mechanical ventilation for more than 24 hours
排除标准
- •early decision to withdraw care (taken in the first 24 hours in ICU),
- •death in the first 24 hours
结局指标
主要结局
Mechanical ventilatory free days
时间窗: Day-90
The number of ventilator-free days was defined as the number of days from day 1 to day 90 on which a patient breaths spontaneously and is alive
次要结局
- Acute respiratory distress syndrome / acute lung injury(day-90)
- Mortality(day-90)
- ICU free days at day 90(day 90)
- Intracranial pressure(day-5)
- Ventilatory setting(day-5)
- In-ICU mortality(90 days)
- Extubation failure(day-90)
- Duration of mechanical ventilation(90 days)
- Hospital acquired pneumonia(day-90)
- Blood gaz(day-5)
- Glasgow outcome scale(day-90)