A feasibility study examining the use of Mechanical Insufflation Exsufflation to promote extubation success in adult intensive care

niversity Hospitals Bristol and Weston NHS Foundation Trust0 个研究点目标入组 47 人开始时间: 2022年5月16日最近更新: 2023年10月3日

试验速览

2023 Protocol article in https://pubmed.ncbi.nlm.nih.gov/37488566/ (added 25/07/2023)

•1. Adult (>=16 years)
•2. Expected to require invasive mechanical ventilation for >48hrs
•3. Clinician identified pre-extubation problems with secretion management defined as poor/weak cough effort (cough peak flow <60L/min) and/or secretion load that are difficult to clear with usual airway clearance management (as assessed by the treating clinical team)
•4. Identified as ‘ready to wean or weaning’ by the treating clinical team (on a spontaneous mode of ventilation for example Continuous Positive Airway Pressure (CPAP); Assisted Spontaneous Breathing (ASB); Pressure Support Ventilation (PSV); Airway Pressure Release Ventilation (APRV) (with spontaneous effort).

•1. Positive End Expiratory Pressure (PEEP) >10
•2. Fraction of Inspired Oxygen (FiO2) >0.7
•3. Hemodynamic/Cardiovascular instability (i.e. noradrenaline >0.25mg/kg, arrhythmias requiring intervention)
•4. Recent undrained pneumothorax (current admission with no chest drain in situ);
•5. Unable to continue to use MI-E post extubation (i.e. contraindications to facemask use-facial/cranial trauma, recent facial surgery; active upper gastrointestinal bleeding/uncontrolled vomiting; recent upper abdominal/thoracic surgery with at risk anastomosis)
•6. Pre-existing neuromuscular respiratory condition
•7. Pre-existing routine use of MI-E in the community
•8. Patients with pre-existing permanent tracheostomy
•9. Treatment withdrawal expected within 24hrs or not expected to survive
•10. Re-admission to ICU following index admission
•11. Previous MERIT trial participation

发起方

niversity Hospitals Bristol and Weston NHS Foundation Trust