An interventional study of Abolish Lung Sliding and Normal Lung Ultrasound in Difficult-to-wean Adult Patients, sponsored by Hospital Ernesto Dornelles. Status unknown at 1 site in Brazil. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2012-11-09.
Sponsored by Hospital Ernesto Dornelles · Not applicable, Interventional, and Supportive care
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.
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:
Hospital Ernesto Dornelles is the lead sponsor of 3 studies on the registry; none are open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
If there is no lung sliding - evaluation for pneumothorax or mainstream intubation. If lung ultrasound shows normal pattern - search for reversible airway obstruction or venous embolism. If the patient has COPD, non invasive ventilation must be used as mode of discontinuing mechanical ventilation. If lung ultrasound shows intersticial syndrome - evaluate the need to negativate hydric balance before the next spontaneous breathing trial. If findings are asymmetrical - search for new or uncontrolled infection. If there is simple pleural effusion - researchers should determine a negativation of hydric balance or perform thoracocentesis. If there are signs of complicated pleural effusion - a new image technique should be performed as evaluated by the surgical team.
Other: Abolish Lung Sliding · Other: Normal Lung Ultrasound · Other: Pulmonary Interstitial Syndrome · Other: Asymmetrical Lung Ultrasound · Other: Simple Pleural Effusion · Other: Complex Pleural Effusion
If there is no lung sliding, the patient will be promptly evaluated for pneumothorax or mainstream intubation.
If the patient fails the spontaneous breathing trial and the lung ultrasound examination is normal - researchers will investigate venous thrombosis (deep vein thrombosis and/or pulmonary embolism) and rule out reversible airway obstruction. If the patient has the previous diagnosis of COPD, non invasive mechanical ventilation is indicated for facilitate weaning.
If lung ultrasound shows "B pattern" - cardiogenic pulmonary edema will be differentiated from Acute Respiratory Distress Syndrome (ARDS). If cardiogenic edema is a possibility, diuretics will be administrated (at least 40 mg of furosemide) or ultrafiltration will be performed. The main target is a negative fluid balance of, at least, 1000 ml before the next spontaneous breathing trial. Another possibility is to titrate vasodilators (at least a 20% reduction in the systolic blood pressure) before the next spontaneous breathing trial.
Also known as: B Lines
If lung ultrasound shows asymmetrical findings, the occurence of new or uncontrolled infection (pulmonary or extrapulmonary) will be investigated.
Also known as: AB Profile or Consolidation
If the patient has pleural effusion without ultrasonographic signs of complications (any hyperechoic pattern or complex septated pattern), researchers will administrate diuretics (at least 40 mg of furosemide in 24 hours) or increase ultrafiltration - to achieve a negative fluid balance of, at least, 1000 ml before the next spontaneous breathing trial. Another possibility is to perform pleural drainage.
If there is pleural effusion with hyperechoic or septated pattern, another image exam will be performed and evaluated by the surgical team.
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)
Number of tracheostomies performed
Time frame: patients follow-up will continue until weaning from mechanical support, up to 2 months
Length of ICU stay
Time frame: from icu admition until icu discharge, up to 2 months
Incidence of ventilation-associated pneumonia
Time frame: until icu discharge, up to 2 months
ICU's, Hospital's and 28-days mortality
Time frame: until ICU's and hospital's discharge and 28th day from ICU admisson, with an expected average of 4 weeks
Performance status at ICU's and Hospital's discharge
Time frame: at icu's and hospital discharge, with an expected average of 4 weeks
Correlation between findings from ultrasound and other image techniques
Time frame: after data collection (1 year) - retrospective review
Duration of Weaning
Time frame: From first failed spontaneous breathing trial or failed extubation until weaning from mechanical ventilation support, up to 4 weeks
This study is status unknown, as verified in Nov 2012. You cannot join it, but the record below documents what was studied.
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Hospital Ernesto Dornelles