Effect of lung volume preservation during spontaneous breathing trial on successful extubation in patients receiving mechanical ventilation: protocol for a multicenter clinical trial

BackgroundIn standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices mig...

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Detalles Bibliográficos
Autores: Subirà, C, Rognoni, G, Baquerizo, H, Garcia, C, Cabanes, S, de la Torre, M, Quevedo, B, Pedros, C, Tizon, AI, Murillo, N, Parro, L, Eiras, F, Rialp, G, Altaba, S, Gonzalez-Castro, A, Pacheco, AF, Bayoumi, P, Gomez-Medrano, N, Vallverdu, I, Higon, A, Navarro, MD, Falcon, A, Keough, E, Arizo, D, Martinez, JF, Duran, N, Rodriguez, R, Popoviciu-Koborzan, MR, Guerrero, I, Concha, P, Barral, P, Batlle, M, Cano, S, Garcia-Castrillon, S, Andorra, X, Tua, Y, Arnau, A, Fernandez, R
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p17549
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/17549
Access Level:acceso abierto
Palabra clave:Mechanical ventilation
Weaning
Spontaneous breathing trial
Extubation
Lung ultrasound
Descripción
Sumario:BackgroundIn standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation. MethodsThis multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization. DiscussionWe aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients

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