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Regional Diaphragmatic Synchrony Index for Predicting Weaning Outcomes During Pressure Support Ventilation Spontaneous Breathing Trials

23. juli 2026 opdateret af: Huiqing Ge, Sir Run Run Shaw Hospital

Regional Diaphragmatic Synchrony Index for Predicting Weaning Outcomes During Pressure Support Ventilation Spontaneous Breathing Trials: A Prospective Observational Study

The primary aim of this study is to evaluate the predictive value of the inspiratory regional diaphragmatic synchrony index (RDSI-insp) during PSV-SBT for first-attempt weaning failure. Secondary objectives include: (1) assessing the correlation between RDSI-insp and conventional respiratory mechanics and diaphragmatic ultrasound parameters such as RSBI, MIP/NIF, VC, CPF, P0.1, DE, and DTF; (2) comparing differences in RDSI and DPSI between successful and failed weaning groups during inspiration, end-inspiration, and expiration; (3) exploring the association of anterior diaphragmatic dyssynchrony index, posterior/crural dyssynchrony index, and regional time-to-peak dispersion with weaning outcomes; and (4) evaluating the feasibility, analyzable image rate, and repeatability of diaphragmatic speckle-tracking and RDSI calculation in patients undergoing PSV-SBT.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Undersøgelsestype

Observationel

Tilmelding (Anslået)

110

Kontakter og lokationer

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Studiekontakt

  • Navn: Huiqing Ge, MD
  • Telefonnummer: +8613588706787
  • E-mail: gehq@zju.edu.cn

Undersøgelse Kontakt Backup

Deltagelseskriterier

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Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

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Ingen

Prøveudtagningsmetode

Sandsynlighedsprøve

Studiebefolkning

The study population will consist of adult patients (aged 18 years and older) who have received invasive mechanical ventilation for at least 24 hours and are clinically ready for their first Spontaneous Breathing Trial (SBT) under Pressure Support Ventilation (PSV) mode. Eligible participants must be hemodynamically stable (MAP ≥ 65 mmHg with or without low-dose vasopressors) and have adequate oxygenation (FiO2 ≤ 0.60 and PEEP ≤ 10 cmH2O) to safely undergo the SBT. Patients with known diaphragm paralysis, inadequate ultrasound windows, severe agitation, or those who are pregnant will be excluded. Written informed consent will be obtained from the patient or their legally authorized representative prior to enrollment.

Beskrivelse

Inclusion Criteria:

  • Age: Age ≥ 18 years.
  • Mechanical Ventilation Duration: Receiving invasive mechanical ventilation for ≥ 24 hours.
  • Weaning Readiness: The attending physician has determined that the patient meets the criteria for weaning assessment and plans to conduct a Spontaneous Breathing Trial (SBT) under Pressure Support Ventilation (PSV) mode.
  • Hemodynamic Stability: Hemodynamically stable prior to the SBT, defined as a mean arterial pressure (MAP) ≥ 65 mmHg, or requiring only low-dose vasopressor support.
  • Oxygenation Criteria: Oxygenation status permits an SBT, typically defined as FiO2 ≤ 0.60 and PEEP ≤ 10 cmH2O, or meeting the standard weaning assessment criteria of the participating institution.

Exclusion Criteria:

  • Known or highly suspected phrenic nerve injury, or unilateral/bilateral diaphragmatic paralysis.
  • Neuromuscular diseases causing severely restricted spontaneous breathing capacity, as judged by the investigator to be unsuitable for RDSI analysis.
  • Recent chest or upper abdominal surgery, open trauma, skin infection, or extensive dressing coverage that prevents obtaining a reliable diaphragm ultrasound window.
  • Significant agitation or severe patient-ventilator asynchrony that prevents the acquisition of continuous and stable respiratory cycles.
  • Undrained pneumothorax, or conditions deemed unsuitable for ultrasound examination as judged by the attending physician.
  • Pregnant patients.
  • The patient or their legally authorized representative refuses to participate in the study.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Kohorter og interventioner

Gruppe / kohorte
Intervention / Behandling
Weaning Success
Patients who successfully pass the first PSV-SBT and remain free from reintubation or rescue non-invasive ventilation (NIV)/high-flow nasal cannula (HFNC) for at least 48 hours post-extubation due to respiratory failure or failure of airway protection.
Enhed: Diagnostic Procedure: Diaphragm Ultrasound and Weaning Assessment
Patients undergoing their first Spontaneous Breathing Trial (SBT) under Pressure Support Ventilation (PSV) will receive diaphragm ultrasound examinations. The investigators will measure diaphragm excursion (DE) and thickening fraction (DTF) to calculate the Respiratory Diaphragm-SB Index (RDSI). Conventional weaning parameters (RSBI, MIP, P0.1, etc.) will also be recorded simultaneously. The results will be compared to predict weaning outcomes (successful extubation vs. failure/reintubation).
Weaning Failure
Patients who fail the first PSV-SBT, or those who pass the SBT but require reintubation or rescue NIV/HFNC within 48 hours post-extubation due to respiratory failure or failure of airway protection.
Enhed: Diagnostic Procedure: Diaphragm Ultrasound and Weaning Assessment
Patients undergoing their first Spontaneous Breathing Trial (SBT) under Pressure Support Ventilation (PSV) will receive diaphragm ultrasound examinations. The investigators will measure diaphragm excursion (DE) and thickening fraction (DTF) to calculate the Respiratory Diaphragm-SB Index (RDSI). Conventional weaning parameters (RSBI, MIP, P0.1, etc.) will also be recorded simultaneously. The results will be compared to predict weaning outcomes (successful extubation vs. failure/reintubation).

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Rate of first-attempt weaning failure
Tidsramme: Up to 48 hours post-extubation (or duration of the first PSV-SBT if failed)
First-attempt weaning failure, defined as failure of the first PSV-SBT, or extubation following a successful SBT but requiring reintubation within 48 hours due to respiratory failure or failure of airway protection.
Up to 48 hours post-extubation (or duration of the first PSV-SBT if failed)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Rescue NIV/HFNC within 48 or 72 hours post-extubation
Tidsramme: - Up to 72 hours post-extubation
- Proportion of patients requiring reintubation for any reason (e.g., respiratory failure, decreased airway protection) within 72 hours after extubation.
- Up to 72 hours post-extubation
- Rescue NIV/HFNC within 48 or 72 hours post-extubation
Tidsramme: - Up to 48 hours or 72 hours post-extubation
- Proportion of patients requiring urgent initiation of non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) due to respiratory distress or hypoxemia within 48 or 72 hours after extubation.
- Up to 48 hours or 72 hours post-extubation
- Ventilator-free days at 28 days (D28)
Tidsramme: - Up to 28 days post-enrollment
- The number of days from the first successful weaning and extubation until day 28, during which the patient is alive and free from invasive mechanical ventilation. If the patient dies or remains on mechanical ventilation for more than 28 days, it is recorded as 0 days.
- Up to 28 days post-enrollment
- Length of stay in the ICU and hospital
Tidsramme: From the date of randomization until the date of ICU discharge or hospital discharge, whichever came first, assessed up to 12 months.
- The number of days from enrollment (day of first SBT) to ICU discharge, and from enrollment to final hospital discharge.
From the date of randomization until the date of ICU discharge or hospital discharge, whichever came first, assessed up to 12 months.
- ICU mortality and in-hospital mortality
Tidsramme: From the date of randomization until the date of ICU discharge or death, whichever came first, assessed up to 12 months.
- The proportion of patients who die during their ICU stay and during the entire hospital stay (until discharge).
From the date of randomization until the date of ICU discharge or death, whichever came first, assessed up to 12 months.
- Correlation between RDSI and conventional respiratory mechanics/diaphragm ultrasound parameters
Tidsramme: At the end of the first PSV-SBT (approximately 30 to 120 minutes post-initiation)
- Assessment of the statistical correlation between the novel RDSI index and conventional weaning predictors, including Rapid Shallow Breathing Index (RSBI), Maximum Inspiratory Pressure (MIP/NIF), Vital Capacity (VC), Cough Peak Flow (CPF), Airway Occlusion Pressure (P0.1), Diaphragmatic Excursion (DE), and Diaphragm Thickening Fraction (DTF).
At the end of the first PSV-SBT (approximately 30 to 120 minutes post-initiation)
- Feasibility and reliability of RDSI image acquisition and speckle tracking
Tidsramme: At the end of the first PSV-SBT, up to 120 minutes post-initiation (upon image completion)
- Assessment of the acquisition rate of diaphragm ultrasound images, the analyzability rate (proportion of successful speckle tracking analysis), and the inter-observer and intra-observer measurement agreement (Intraclass Correlation Coefficient, ICC).
At the end of the first PSV-SBT, up to 120 minutes post-initiation (upon image completion)

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Sir Run Run Shaw Hospital

Publikationer og nyttige links

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Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

23. august 2026

Primær færdiggørelse (Anslået)

21. august 2027

Studieafslutning (Anslået)

30. august 2027

Datoer for studieregistrering

Først indsendt

5. juli 2026

Først indsendt, der opfyldte QC-kriterier

23. juli 2026

Først opslået (Faktiske)

29. juli 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

29. juli 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

23. juli 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • 20260625

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