Dynamic Airway Resistance & ML: Guide Sputum Suction in Ventilated Patients

Mechanisms of Dynamic Airway Resistance Monitoring and Machine Learning for Assessing Pulmonary Inflammation and Guiding Sputum Suction in Mechanically Ventilated Patients

Research has shown that timely suctioning not only improves survival rates but also enhances the quality of life in ventilator-dependent patients. However, clinical judgment on the optimal timing for suctioning currently relies primarily on physician experience, lacking scientific evidence [10]. Airway viscous resistance reflects the frictional resistance encountered by gas flow within the airways and is closely associated with airway patency. When airway secretions increase, viscous resistance undergoes dynamic changes. Therefore, analyzing these dynamic variations in viscous resistance derived from ventilator waveforms to determine the optimal suctioning timing and assess its clinical impact on the progression of pulmonary inflammation holds significant scientific value and offers new insights and methodologies for clinical practice.

Study Overview

• Status: Recruiting
• Conditions: Mechanical Ventilation Pressure High; Ventilator-Associated Pneumonia (VAP); Respiratory Depression Neonatal
• Intervention / Treatment: Procedure: The dynamics of airway resistance; Diagnostic test: conventional suctioning

Detailed Description

To validate the clinical feasibility and reliability of airway viscous resistance monitoring, explore the temporal correlation between inflammatory biomarkers and changes in airway viscous resistance, establish a reference threshold system for special populations, and provide experimental evidence for determining the optimal suctioning timing.

• Study Type: Interventional
• Enrollment (Estimated): 258
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hong-lei Wu Nursing Department, MS; Phone Number: +8613862749927; Email: wu_honglei@163.com
• Study Contact Backup: Name: xuan Qian Nursing Department, MS; Phone Number: +8615162763676; Email: 1660694568@qq.com

Study Locations

• China
  • Anhui
    • Bengbu, Anhui, China, 233000
      • Recruiting
      • The First Affiliated Hospital of Bengbu Medical University
      • Contact: Yajun Li Director of the Nursing, MS; Phone Number: +8615955232235; Email: liyajun1205@163.com
  • Beijing Municipality
    • Beijing, Beijing Municipality, China, 100000
      • Recruiting
      • Peking Union Medical College Hospital
      • Contact: Zunzhu Li Director of the Nursing, MS; Phone Number: +8618612671363; Email: 1981285238@qq.com
  • Zhejiang
    • Hangzhou, Zhejiang, China, 310009
      • Recruiting
      • The Second Affiliated Hospital of Zhejiang University School of Medicine
      • Contact: Mei-juan Lan Director of the Nursing Department, MS; Phone Number: +8613757119537; Email: lmj3632@126.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Clinical diagnosis of Acute Respiratory Distress Syndrome (ARDS)
• Clinical diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)
• Clinical diagnosis of Severe pneumonia

Exclusion Criteria:

• Clinical diagnosis of multiple organ failure;
• Clinical diagnosis of multiple organ bleeding;

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Airway resistance-guided sputum suction; Investigators will continuously monitor the airway viscous resistance of patients, and initiate suctioning when the airway viscous resistance increases by ≥6 cmH₂O.	Procedure: The dynamics of airway resistance; Monitoring the dynamic changes in airway resistance in patients can be used to reflect the progression of pulmonary inflammation and determine the optimal timing for suctioning.; Diagnostic test: conventional suctioning; The timing for suctioning is determined based on clinical signs such as rhonchi and an elevated peak pressure.
No Intervention: conventional suctioning; In the control group, the decision to suction was made based on conventional clinical signs, including rhonchi and a rise in peak pressure.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The drop in airway viscous resistance before and after sputum suction	Airway viscous resistance drop (AVRD) is the primary efficacy endpoint of this study. It is defined as the difference in airway viscous resistance measured immediately before and after suctioning. Procedure: Record the ventilator-displayed viscous resistance value pre-suction; immediately after the maneuver, re-measure both viscous resistance and peak airway pressure with a high-precision pressure-time sensor. Calculation: The within-patient difference (pre minus post) is the AVRD. In a pilot study of nine patients, AVRD averaged 6.889 ± 3.551 cmH₂O, significantly larger than the concurrent peak-pressure drop (1.556 ± 1.740 cmH₂O), indicating that AVRD is more sensitive to the effect of suction on airway secretions. Clinical implication: AVRD can serve as a quantitative criterion for determining the optimal timing of endotracheal suction.	the process of sputum aspiration(at most 30 minutes)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The number of participants with abnormal laboratory tests	Venous blood testing was performed, including a complete blood count (white blood cell count [WBC], neutrophil percentage [NEUT%]), C-reactive protein (CRP), and procalcitonin (PCT) to assess the systemic inflammatory status.	Laboratory testing time ( at least 30 minutes)
Sputum bacterial culture	Sputum culture is performed to identify the source of infection and to diagnose VAP.	3 days

Collaborators and Investigators

• Sponsor: Affiliated Hospital of Nantong University

Study record dates

Study Major Dates

• Study Start (Actual): October 30, 2025
• Primary Completion (Estimated): December 30, 2028
• Study Completion (Estimated): December 30, 2029

Study Registration Dates

• First Submitted: December 10, 2025
• First Submitted That Met QC Criteria: January 26, 2026
• First Posted (Actual): January 29, 2026

Study Record Updates

• Last Update Posted (Actual): January 29, 2026
• Last Update Submitted That Met QC Criteria: January 26, 2026
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: Airway resistance
• Additional Relevant MeSH Terms: Healthcare-Associated Pneumonia; Pathologic Processes; Disease Attributes; Respiratory Tract Infections; Infections; Respiratory Tract Diseases; Lung Diseases; Pneumonia; Cross Infection; Iatrogenic Disease; Pathological Conditions, Signs and Symptoms; Pneumonia, Ventilator-Associated
• Other Study ID Numbers: 2025-K249-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All data
• IPD Sharing Time Frame: From October 2025 until the end of the trial
• IPD Sharing Access Criteria: Critical care researchers; all materials will be made available. Contact: Honglei Wu, e-mail: wu_honglei@163.com
• IPD Sharing Supporting Information Type: CSR

Drug and device information, study documents

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