Ventilator Asynchrony as a Predictor of Weaning Failure

Patient Ventilator Asynchrony as a Predictor of Weaning Failure in Mechanically Ventilated COPD Patients

Patient ventilator asynchrony is a common problem in mechanically ventilated patients .It is associated with adverse effects including increased work of breathing, patient discomfort, increased need for sedation, prolonged mechanical ventilation , weaning difficulties and weaning failure. 100 mechanically ventilated COPD patients were enrolled in this prospective study .Detection of patient ventilator asynchrony was done on 30-minute sessions at 12, 24, 36, and 48 hours following intubation by visual assessment of pressure, flow and volume graphs on ventilator .

Study Overview

• Status: Completed
• Conditions: Chronic Obstructive Pulmonary Disease(COPD)

Detailed Description

Patient-ventilator asynchrony is defined as a lack of organization between the patient and ventilator timing of both inspiration and expiration . It is a commonly reported problem during mechanical ventilation. Thille et al. found that 24% of patients developed asynchrony in at least ten percent of their breaths, moreover they stated that the most frequent asynchronies was each of ineffective triggering and double triggering . Eighty percent of chronic obstructive pulmonary disease (COPD) patients experienced ineffective triggering, where it is considered the most frequent asynchrony in this group of patients. Asynchrony between Patient and ventilator also leads to prolonged duration of invasive ventilation, and increase possibility of weaning failure.

Both spread and intensity of asynchrony during the early phase of weaning in COPD patients has never satisfactorily described. The aim of the current study was to describe the patient-ventilator asynchrony and its impact on weaning outcome in mechanically ventilated COPD patients.

• Study Type: Observational
• Enrollment (Actual): 100

Contacts and Locations

Study Locations

• Egypt
  • Assuit, Egypt, 71515
    • Assuit University Hospital

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

All COPD patients who were diagnosed after history ,physical examination ,radiology and pulmonary function tests and required mechanical ventilation.

Description

Inclusion Criteria:

All COPD patients who were diagnosed after history ,physical examination radiology and pulmonary function tests and required mechanical ventilation.

Exclusion Criteria:

1. Age < 18 years
2. Tracheostomy
3. Failure to trigger breaths even in cases of receiving neuromuscular blocking agents.
4. Encephalopathy which is not caused by hypercapnia or hypoxemia either post arrest or due to cerebrovascular stroke
5. Patients with unplanned weaning

6. COPD patients where intubation not related to exacerbation e.g. acute pulmonary edema.

   -

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Failed Weaning; Patients who failed to be liberated from mechanical ventillation
Successful Weaning; Patients who were liberated from mechanical ventillation and needed no respiratory support

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To study effect of different types of ventilator asynchrony on weaning in mechanically ventilated COPD patients	Detection of patient ventilator asynchrony was done on 30-minute sessions following intubation by visual assessment of pressure, flow and volume graphs on ventilator .Repeated measures are done from the begining of mechanical ventilation and type of asynchronies including ineffective trigger double trigger, auto trigger , delayed cycle, early cycle and flow asynchrony. were recorded.	One year

Collaborators and Investigators

• Sponsor: Reham Mohammed Elmorshedy
• Investigators: Principal Investigator: Samiaa Sadek, Ass.Lecturer, Assiut University

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2018
• Primary Completion (Actual): August 15, 2019
• Study Completion (Actual): December 20, 2019

Study Registration Dates

• First Submitted: January 11, 2021
• First Submitted That Met QC Criteria: January 28, 2021
• First Posted (Actual): February 3, 2021

Study Record Updates

• Last Update Posted (Actual): February 10, 2021
• Last Update Submitted That Met QC Criteria: February 9, 2021
• Last Verified: February 1, 2021

More Information

Terms related to this study

• Keywords: COPD; mechanically ventilated; weaning failure; asynchrony
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
• Other Study ID Numbers: Ventilator Asynchrony

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No