Critical Care Ultrasound Guided Weaning

Weaning patients from the ventilator in the intensive care unit is sometimes difficult because of three main interrelated etiologies: impaired lung, heart or diaphragm function. In this context, ultrasonography performed during tests for extubation of patients may enable the diagnosis of cardiac dysfunction, loss of pulmonary aeration, diaphragm dysfunction, and venous congestion, thereby reducing the number of failures in extubation.

The combination of TTE (Trans Thoracic Echocardiography), LUS (Lung Ultrasound), DUS (Diaphragmatic ultrasound) and VEXUS (Venous excess Ultrasound) may enable the identification of the etiology of weaning failure and reduce the number of extubation failures by enabling the development of an appropriate treatment strategy. With this study, it is aimed to contribute to the literature in this sense.

Study Overview

• Status: Completed
• Conditions: Weaning Failure

Detailed Description

The aim of this study is to reduce the number of extubation failures by defining the etiology of weaning failure and developing appropriate treatment strategies by using intensive care ultrasonography applications in combination (defining cardiac, pulmonary, diaphragmatic and venous congestion).

Most patients can be extubated after the first SBT (spontaneous Breathing Trial). A patient who fails extubation is automatically classified as difficult weaning, and intensive care professionals frequently encounter patients who are difficult to wean from mechanical ventilation.

Before performing a new SBT following a failed SBT, the cause of the failure should be determined and an appropriate treatment strategy developed.

• Study Type: Observational
• Enrollment (Actual): 27

Contacts and Locations

Study Locations

• Turkey
  • Antalya, Turkey, 07059
    • Antalya Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The researchers aimed to predict the success and failure of extubation and measure the associated ultrasound indices with the combined ultrasound-guided weaning protocol in all critically ill patients over the age of 18 who remain on mechanical ventilator for more than 24 hours and are thought to be ready for weaning. Evaluations will be made just before the spontaneous breathing trial and at the end of the spontaneous breathing trial in critically ill patients undergoing mechanical ventilation.

Description

Inclusion Criteria:

• Invasive mechanical ventilation > 24 hours Eligibility to weaning from mechanical ventilation

Exclusion Criteria:

• Age < 18 years old
• Severe skin lesions or infections that cannot perform ultrasound
• Severe subcutaneous emphysema that cannot perform ultrasound
• Patients with a known neuromuscular disease
• Patients with a duration of mechanical ventilation <24 hours,
• Patients with severe mitral stenosis, severe mitral regurgitation, or prosthetic mitral valve

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
weaning failure; Unstable patient without mechanical ventilator support within 48 hours
weaning success; Stable patient for more than 48 hours without mechanical ventilator support

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mechanical ventilation weaning success	Weaning success: stable without mechanical ventilator support during more than 48 hours	48 hours
Mechanical ventilation weaning failure	Weaning failure: unstable without mechanical ventilator support within 48 hours	48 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mortality	Incidence of ICU mortality	ICU mortality after ultrasonography guided weaning

Collaborators and Investigators

• Sponsor: Antalya Training and Research Hospital
• Investigators: Principal Investigator: Şule Asrı, Antalya Training and Research Hospital

Publications and helpful links

General Publications

• Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T. Weaning from mechanical ventilation. Eur Respir J. 2007 May;29(5):1033-56. doi: 10.1183/09031936.00010206.
• Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med. 2017 Oct;43(10):1441-1452. doi: 10.1007/s00134-017-4928-4. Epub 2017 Sep 15.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2023
• Primary Completion (Actual): June 30, 2023
• Study Completion (Actual): July 20, 2023

Study Registration Dates

• First Submitted: February 28, 2023
• First Submitted That Met QC Criteria: February 28, 2023
• First Posted (Actual): March 10, 2023

Study Record Updates

• Last Update Posted (Actual): July 21, 2023
• Last Update Submitted That Met QC Criteria: July 20, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Other Study ID Numbers: ultrasound weaning