A Study on Toilet Bronchoscopy In Respiratory ICU, Assiut University Hospital
试验速览
- 阶段
- 不适用
- 入组人数
- 130
- 试验地点
- 2
- 主要终点
- 3-Lung mechanics reduction post procedure in mechanical ventilated patients
研究概览
简要总结
Toilet bronchoscopy is a potentially therapeutic intervention to aspirate retained secretions within the endotracheal tube and airways and revert atelectasis. Aspiration of airway secretions is the most common indication to perform a therapeutic bronchoscopy in the intensive care unit (ICU) .
Toilet bronchoscopy is particularly beneficial when retained secretions are visible during the procedure and when air-bronchograms are not present at the chest radiograph. It is also beneficial when there is an indication to reverse lobar atelectasis, rather than simply to remove accumulated mucus.
Toilet bronchoscopy is used in lobar and complete lung collapse in mechanically ventilated patients who fail to respond to treatments such as physiotherapy or recruitment manoeuvres.
The success rates (defined as radiographic improvement on chest X-ray [CXR] or an improved PaO2/PAO2 ratio) in the ICU patient population had.
Patients with acute hypoxaemic respiratory failure may already be on non-invasive ventilation (NIV), or require NIV preemptively for Fiberoptic Bronchoscopy (FB). These patients should be considered high risk for requiring intubation post-procedure; therefore, Fiberoptic Bronchoscopy should be performed by an experienced operator in a setting allowing facilities to safely secure the airways. NIV with early therapeutic FB rather than mechanical ventilation can help avoid intubation and reduce tracheostomy rate. Hospital mortality, duration of ventilation, and hospital stay remain similar
详细描述
Aim Of Work To study the value of toilet bronchoscopy in
- Mechanical ventilated patients with chest disease and copious secretion.
- Mechanical ventilated patients diagnosed to have atelectasis radiologically.
- Patients on non-invasive ventilation with chest diseases and copious secretion
- Compare Different types of mucolytics during toilet bronchoscopy in mechanically ventilated patients.
- Compare Different types of sedations during toilet bronchoscopy in mechanically ventilated patients.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •• Patients on mechanical ventilation with underlying dieases that are characterized with mucus overproduction such as asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and cystic fibrosis.
- •Patients on mechanical ventilation with visible large amount of sputum during suction in order to clear secretions.
- •Patients on mechanical ventilation with radiologically diagnosed atelectasis and absent air-bronchograms
- •Patient on NIV who was benefit from toilet bronchoscopy to clear retained secretion.
排除标准
- •Absolute contraindications
- •Absence of consent from the patient or his/her representative.
- •Inability to adequately oxygenate the patient during the procedure.
- •Current myocardial ischaemia.
- •Significant haemodynamic instability.
- •Life-threatening cardiac arrhythmias.
- •Current significant bronchospasm.
- •Undrained pneumothorax.
- •Relative contraindications
- •Thrombocytopenia (platelet count ≤50,000 platelets/mm).
- •INR of 2 or greater, or an elevated PTT.
- •severe tracheal obstruction.
- •Recent myocardial ischaemia and/or unstable angina.
- •Intracranial hypertension.
- •Poorly-controlled heart failure.
- •Recent oral intake.
结局指标
主要结局
3-Lung mechanics reduction post procedure in mechanical ventilated patients
时间窗: 12 months
resistance measured by cm H2o /Liter/ second
1- percent of patients develop radiological improvement
时间窗: 12 months
assessed improvement of atelectasis by chest x-ray or HRCT
2- improvement of hypoxemia
时间窗: 12months
assessed by sao2/fio2 or pao2/fio2 before and after procedure
Lung mechanics improvement post procedure in mechanical ventilated patients
时间窗: 12 months
assessed by static compliance measured by ml/cm H2o
次要结局
- length of ICU stay(12 months)
- occurrence of complications(12 months)
- length of hospital stay(12 months)
- 4-Hospital mortality(12 months)
研究者
Shaimaa Ali Mohammed
Assistant lecturer,chest department and tuberculosis
Assiut University