Echocardiographic Detection of Extravascular Lung Water Increase During Weaning From Mechanical Ventilation

NCT02412202 | Completed

• 1 other identifier: 273/2015
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Switching from positive airway pressure ventilation to spontaneous ventilation during weaning from mechanical ventilation, pulmonary edema may occur and in this case, doppler echocardiographic (U/S) indices of cardiac dysfunction correlates with the concentration of fluid in interstitial space. Forty consecutive mechanically ventilated critical ill patients who fulfill criteria for weaning from mechanical ventilation, will be included in this study. All patients will be evaluated daily and when the patients fulfill weaning criteria them they will undergo a 2-hour spontaneous breathing trial (SBT) through a T-piece. Before and after SBT cardiopulmonary function will be assessed by thermodilution and echocardiography. In patients with preserved LV systolic function, an echocardiographic index of diastolic dysfunction (E/Em ratio) before preforming SBT may identify high risk patients for increasing extravascular water in weaning. In addition, the investigators expect to find positive correlations (p\<0.05) between pulmonary extravascular lung water and echocardiographic indices (such as E/Em ratio) during SBT.

Conditions

Ventilator Weaning

Outcome Measures

Primary Outcomes (1)

• Extravascular water increase during weaning from mechanical ventilation measured by echocardiography and thermodilution method

  24 hours

Study Arms (1)

patients who undergo weaning from mechanical ventilation

OTHER

consecutive mechanically ventilated critical ill patients who fulfil criteria for weaning will be included

Other: Monitoring of pulmonary oedema induced by weaning from mechanical ventilation

Interventions

Monitoring of pulmonary oedema induced by weaning from mechanical ventilation OTHER

patients who undergo weaning from mechanical ventilation

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• adequate oxygenation (pressure of oxygen in arterial blood (PaO2)\>60mmHg with fraction of inspired oxygen (FiO2)\<40%, PEEP\<5-10cmH2O, PaO2/FIO2\>150-300)
• stable cardiovascular system (Heart rate\<140/min, stable blood pressure, without or very minimal vasopressors)
• absence of sepsis and temperature \<38 degree of Celcius
• no respiratory acidosis
• adequate hemoglobin (Hb \> 8-10g/dL)
• sufficient (adequate mentation ) arousable Glasgow coma scale \>13/15, no continuous sedative infusions
• Ramsay score\<3
• stable metabolic status (acceptable levels of electrolytes )
• subjective clinical assessments such as resolution of the acute phase of disease and adequate cough.

You may not qualify if:

• atrial fibrillation or other arrhythmias
• insufficiency of tricuspidal valve ( +++),
• continuous venous-venous hemodialysis

Sponsors & Collaborators

• University of Thessaly: lead

Study Sites (1)

University Hospital Larissa

Larissa, Greece

Location

Related Publications (6)

• Kennedy SK, Weintraub RM, Skillman JJ. Cardiorespiratory and sympathoadrenal responses during weaning from controlled ventilation. Surgery. 1977 Aug;82(2):233-40.

  PMID: 877867 BACKGROUND

• Buda AJ, Pinsky MR, Ingels NB Jr, Daughters GT 2nd, Stinson EB, Alderman EL. Effect of intrathoracic pressure on left ventricular performance. N Engl J Med. 1979 Aug 30;301(9):453-9. doi: 10.1056/NEJM197908303010901.

  PMID: 460363 BACKGROUND

• Hurford WE, Favorito F. Association of myocardial ischemia with failure to wean from mechanical ventilation. Crit Care Med. 1995 Sep;23(9):1475-80. doi: 10.1097/00003246-199509000-00006.

  PMID: 7664548 BACKGROUND

• Boussuges A, Pinet C, Molenat F, Burnet H, Ambrosi P, Badier M, Sainty JM, Orehek J. Left atrial and ventricular filling in chronic obstructive pulmonary disease. An echocardiographic and Doppler study. Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):670-5. doi: 10.1164/ajrccm.162.2.9908056.

  PMID: 10934104 BACKGROUND

• Routsi C, Stanopoulos I, Zakynthinos E, Politis P, Papas V, Zervakis D, Zakynthinos S. Nitroglycerin can facilitate weaning of difficult-to-wean chronic obstructive pulmonary disease patients: a prospective interventional non-randomized study. Crit Care. 2010;14(6):R204. doi: 10.1186/cc9326. Epub 2010 Nov 15.

  PMID: 21078149 BACKGROUND

• Isakow W, Schuster DP. Extravascular lung water measurements and hemodynamic monitoring in the critically ill: bedside alternatives to the pulmonary artery catheter. Am J Physiol Lung Cell Mol Physiol. 2006 Dec;291(6):L1118-31. doi: 10.1152/ajplung.00277.2006. Epub 2006 Aug 4.

  PMID: 16891389 BACKGROUND

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: AS. PROFESSOR

Study Record Dates

• First Submitted: March 27, 2015
• First Posted: April 9, 2015
• Study Start: March 1, 2015
• Primary Completion: December 1, 2015
• Last Updated: December 2, 2015

Record last verified: 2015-12

Locations

GR (1)