ICU Predictive Score of WEaning Success in Patients At Risk of Extubation Failure

  • STATUS
    Recruiting
  • End date
    Sep 28, 2023
  • participants needed
    300
  • sponsor
    University Hospital, Clermont-Ferrand
Updated on 20 November 2021

Summary

Observational study in two medical-surgical intensive care units of the Clermont-Ferrand University Hospital to develop a composite score for prediction of 72h-extubation failure in patients at risk of extubation failure.

Description

In our intensive care units, when a patient does not have risk factors for extubation failure, SBT (Spontaneous Breathing Trial) in PSV (Pressure Support Ventilation) is usually performed first as recommended. If patient fails the first SBT in PSV or extubation, weaning is considered difficult (WIND study group AJRCCM 2017). In this case, the service protocol provides a T-piece SBT for the following SBT. In addition, this same protocol proposes to perform T-piece SBT from the first weaning event in patients with risk factors for WiPO (Weaning-induced Pulmonary Oedema), defined as obesity (BMI >30 kg/m2), COPD (Chronic Obstructive Pulmonary Disease) (suspected or known), or heart disease (structural [hypertrophic, dilated, valvular], functional [diastolic or systolic dysfunction], ischemic, or dysrhythmic).

Our study population concerns patients for whom a T-piece trial is performed according to the service protocol.

A patient is potentially includible in the study if he has been under mechanical ventilation for at least 48h and if he presents criteria of weanability with a planned T-piece SBT. As long as the inclusion and non-inclusion criteria are respected (see inclusion/non-inclusion criteria), clinical, biological and ultrasound data will be collected before and at the end of the ventilatory weaning test. If the patient fails the weaning test and/or is not extubated following the test, data from each new T-piece SBT will be collected within 7 days of inclusion.

The global management of the patient, before, during and after the inclusion of the patient in the study is the one usually practiced in our intensive care units, based on the national and international recommendations as well as the literature exposed in the protocol.

During the patient's stay in the ICU, data from the medical record will be collected (demographic, clinical, treatment, vital status,...). A follow-up at D7, D28 and D90 will be performed.

Details
Condition Sensitivity, ultrasonic diagnosis, Echocardiography, Logistic Regression, Airway Extubation, Biomarkers / Blood, intensive care unit, Critical Care, Ventilator Weaning, Prospective Studies, AUC, Ultrasound, Predictive Value of Tests
Clinical Study IdentifierNCT05114551
SponsorUniversity Hospital, Clermont-Ferrand
Last Modified on20 November 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Age > 18 years
Invasive mechanical ventilation for at least 48 hours
Criteria for ventilatory weaning are present
T-piece spontaneous breathing trial planned
Patients with a social security program

Exclusion Criteria

Patients already included in this study during the same stay in intensive care
Resuscitation neuromyopathy defined by an MRC (Medical Research Council) score < 48/60
Surgery planned within 72 hours
Prolonged ventilatory weaning (>7 days after the first SBT)
Patients with tracheostomy
Patients with non-reintubation decision or terminal extubation
Brain damaged patients
Patients with ECMO/ECLS
Tetraplegic or paraplegic patients with lesion level higher than T8
Nasotracheal intubated patients
Pregnant or breastfeeding women
Refusal to participate in the study (refusal by patient or family member/trusted person)
Patients under guardianship
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