Daily Lung Ultrasound Assisting Weaning From Mechanical Ventilation in Difficult-to-wean Adult Patients - a Randomized Trial.
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Difficult-to-wean Adult Patients
- Sponsor
- Hospital Ernesto Dornelles
- Enrollment
- 128
- Locations
- 1
- Primary Endpoint
- Time in mechanical ventilation
- Last Updated
- 13 years ago
Overview
Brief Summary
Daily lung ultrasound can help weaning from mechanical ventilation in difficult-to-wean adult patients. In this randomized trial, standardized lung ultrasound will be performed daily asssociated with standardized interventions aiming to decrease the total time in mechanical ventilation.
Detailed Description
This trial will be performed in two intensive care units (ICUs). After randomization, all patients in the intervention group will undergo daily lung ultrasounds before the next spontaneous breathing trial. The results from the lung ultrasound will indicate specific interventions to facilitate weaning: * No sign of lung sliding (ultrasound finding suggestive of pleural movement): prompt evaluation for pneumothorax or mainstream intubation will be indicated; * normal lung ultrasound (ultrasound A profile): the patient will be evaluated for deep vein thrombosis / pulmonary embolism and/or for reversible airway obstruction (e.g. uncontrolled asthma or COPD \[Chronic Obstructive Pulmonary Disease\] exacerbation)- followed by appropriate treatment. If the patient has COPD, non invasive mechanical ventilation must be used as mode of discontinuing mechanical ventilation; * lung ultrasound shows pulmonary edema (ultrasound B profile): cardiogenic pulmonary edema will be differentiated from acute Respiratory Distress Syndrome (ARDS) - followed by appropriate treatment (e.g. a negative fluid balance of, at least, 1000 ml before the next spontaneous breathing trial); * lung ultrasound shows asymmetrical patterns (ultrasound AB profile or Pulmonary Consolidation): the possibility of an uncontrolled infection will be investigated; * presence of simple pleural effusion: diuretics will be indicated (for a negative fluid balance of, at least, 1000 ml before the next spontaneous breathing trial) or thoracocentesis at description of the assistant team; * presence of complex pleural effusion: other image exam will be performed, and will be evaluated by the surgical team.
Investigators
Felippe Leopoldo Dexheimer Neto
M.D.
Hospital Ernesto Dornelles
Eligibility Criteria
Inclusion Criteria
- •Difficult to Wean;
- •1 failure in the spontaneous breathing trial or 1 extubation failure
- •Adult patients (over 18 years old);
Exclusion Criteria
- •Palliative Care;
- •Life expectancy under 90 days;
- •COPD Gold IV, Cirrhosis Child C, Metastatic Cancer with low performance, etc
- •Other weaning method than institutional protocol
Outcomes
Primary Outcomes
Time in mechanical ventilation
Time Frame: from intubation until extubation success (defined as weaning from mechanical support for, at least, 48 hours) or death (days)
Secondary Outcomes
- Length of ICU stay(from icu admition until icu discharge, up to 2 months)
- Incidence of ventilation-associated pneumonia(until icu discharge, up to 2 months)
- Performance status at ICU's and Hospital's discharge(at icu's and hospital discharge, with an expected average of 4 weeks)
- Correlation between findings from ultrasound and other image techniques(after data collection (1 year) - retrospective review)
- Duration of Weaning(From first failed spontaneous breathing trial or failed extubation until weaning from mechanical ventilation support, up to 4 weeks)
- ICU's, Hospital's and 28-days mortality(until ICU's and hospital's discharge and 28th day from ICU admisson, with an expected average of 4 weeks)
- Number of tracheostomies performed(patients follow-up will continue until weaning from mechanical support, up to 2 months)