Weaning And Variability Evaluation (WAVE) (WAVE)

Weaning And Variability Evaluation

The purpose of this study is to determine if variability in heart and breathing rates can be used to predict successful weaning. We are collecting data to determine whether or not subtle differences in heart rate and respiratory function will help physicians to decide if a patient is ready to be weaned.

Study Overview

• Status: Completed
• Conditions: Extubation

Detailed Description

In this prospective observational pilot study, mechanically ventilated patients weaning or near extubation (i.e. within 1-5 days) were selected to undergo continuous heart rate (EKG waveform at 500 Hz) and respiratory rate (expired CO2 waveform at 100 Hz) recording. The data was collected as per standard practice by the bedside monitor (Phillips Intelivue MP70). A portable CPU with TrendfaceTM software was used to download the data for variability analysis. All decisions on timing of SBTs and extubation were left to the discretion of the treating team who were unaware of the variability results. SBT's were repeated daily from trial onset until extubation patient permitting.

• Study Type: Observational
• Enrollment (Actual): 60

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Ottawa, Ontario, Canada, K1H 8L6
      • The Ottawa Hospital General Campus

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Mechanically ventilated patients weaning or near extubation (i.e. within 1-5 days) in the intensive care unit.

Description

Inclusion Criteria:

• Patients who have been requiring mechanical ventilation for >48 hours.
• At least partial reversal of the condition precipitating invasive ventilation.
• Stabilization of "other" organ system failures (i.e. no worsening).
• The patient is able to tolerate pressure support ventilation ≤14 cm H2O (SpO2 ≥ 90% with FiO2 ≤ 40% and PEEP ≤ 10 cm H2O)
• The patient is hemodynamically stable (off vasopressors or on low levels of vasopressors).
• Stable neurological status (no deterioration in the last 24 hors, intact respiratory drive and ICP < 20).
• The patient has intact airway reflexes (adequate cough with suctioning and a gag reflex).

Exclusion Criteria:

• Allergy to skin adhesives or a contraindication to placing electrocardiogram adhesives (e.g. severe psoriasis).
• Do not reintubate order documented on chart or anticipated withdrawal of life support.
• Tracheostomy
• Known or suspected severe myopathy or neuropathy (i.e. myasthenia gravis, Guillain-Barré syndrome) or quadriplegia.
• Severe heart failure or Grade IV left ventricular function.
• Prior extubation during ICU stay.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Continuous heart rate and respiratory rate waveforms	at time of sponataneous breathing trial (at least 48 hours after intubation and within 24 hours of extubation)

Collaborators and Investigators

• Sponsor: Ottawa Hospital Research Institute
• Collaborators: The Physicians' Services Incorporated Foundation
• Investigators: Principal Investigator: Andrew Seely, MD, PhD, FRCSC, Ottawa Hospital Research Institute

Study record dates

Study Major Dates

• Study Start: November 1, 2007
• Primary Completion (Actual): May 1, 2009
• Study Completion (Actual): May 1, 2009

Study Registration Dates

• First Submitted: March 12, 2010
• First Submitted That Met QC Criteria: March 12, 2010
• First Posted (Estimate): March 15, 2010

Study Record Updates

• Last Update Posted (Actual): July 7, 2017
• Last Update Submitted That Met QC Criteria: July 5, 2017
• Last Verified: July 1, 2017

More Information

Terms related to this study

• Keywords: mechanical ventilation; weaning; extubation
• Other Study ID Numbers: OH2007-588