the Effect of Doxapram on Diaphragmatic Excursion(DE) During Weaning From Mechanical Ventilation.
the Effect of Doxapram on Diaphragmatic Excursion(DE) During Weaning From Mechanical Ventilation :a Randomized Double Blinded Study.
The goal of this clincal trial is to learn if doxapram is effective in weaning in adults on mechanical ventilation.
The objectives of this study:
- Evaluate the effect of doxapram on diaphragmatic function (assessed by DE)during weaning from mechanical ventilation.
- Assess the impact of doxapram on respiratory muscle sterngth.
- Mointor adverse effects associated with doxapram administration.
Researchers will compare expermental group(intervenous doxapram during weaning)with control group(saline infusion)during weaning.
The patients who fulfull criteria of weaning will be subjected to our clincal trial and put on spontanous breathing trial for 120mins using positive end expiratory pressure (peep)5 cmh2o,pressure support 5cm h2o and fio2 0.3.By the end of the SBTthe patient will be extubated if ventilator parameters and vital signs were maintained within 20%of baseline values.
The patients will be followed up after extubation and afailed weaning will be defined as the neeed for either invasive or non invasive ventilation for 72 after extubation or failed SBT.
研究概览
研究类型
注册 (估计的)
阶段
- 第四阶段
联系人和位置
学习联系方式
- 姓名:ahmed mekhemar Mekhemar, doctor
- 电话号码:+201122296845
- 邮箱:totaldamned@gmail.com
参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
描述
Inclusion Criteria:
- Adults (≥18 years) on mechanical ventilation for >48 hours.
- Deemed ready for weaning by the clinical team: Defined as RSBI <105, P/F ratio >200, hemodynamic stability.
- Stable hemodynamics and adequate oxygenation (PaO₂/FiO₂ >150)
Exclusion Criteria:
Severe neurological impairment :Defined as GCS ≤8 or spinal cord injury above T5 .
- Known hypersensitivity to doxapram.
- Pregnancy or lactation.
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:四人间
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
实验性的:Intervenous Doxapram During Weaning.
Patient in this arm will receive intervenous doxapram during weaning from mechanical ventilation in addition to standard weaning care.Diaphragmatic excursion and respiratory parameters will be assessed during weaning process.
|
Doxapram is used as a respiatory stimulant intended to enhance respiratory drive and diaphragmatic activity durig ventilator weaning.
|
|
无干预:Standard Weaning Care.
Paients in this arm will receive standard weaning care without intervenous doxapram infusion.Diaphragmatic excursion and respiratory parameters will be assesseed during the weaning process.
|
研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
|---|---|
|
- Diaphragmatic excursion (DE) measured by ultrasound.
大体时间:Baseline(immediately before initiation of weaning trial) ,and at 15 minutes,60 minutes,and 120 minutes after initiation of weaning trial.
|
Baseline(immediately before initiation of weaning trial) ,and at 15 minutes,60 minutes,and 120 minutes after initiation of weaning trial.
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Maximal Inspiratory Pressure(MIP)
大体时间:Baseline and during weaning trial up to 120 minutes.
|
Baseline and during weaning trial up to 120 minutes.
|
|
|
Weaning Success Rate
大体时间:Within 48hr after extubation.
|
Successful liberation from mechanical ventilation without the need for reintubation or noninvasive ventilatory support.
|
Within 48hr after extubation.
|
其他结果措施
结果测量 |
大体时间 |
|---|---|
|
Duration of ICU Stay
大体时间:From ICU admission until ICU discharge, assessed up to 30 days.
|
From ICU admission until ICU discharge, assessed up to 30 days.
|
合作者和调查者
出版物和有用的链接
一般刊物
- Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ; Mechanical Ventilation International Study Group. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002 Jan 16;287(3):345-55. doi: 10.1001/jama.287.3.345.
- Helmy MA, Magdy Milad L, Osman SH, Ali MA, Hasanin A. Diaphragmatic excursion: A possible key player for predicting successful weaning in patients with severe COVID-19. Anaesth Crit Care Pain Med. 2021 Jun;40(3):100875. doi: 10.1016/j.accpm.2021.100875. Epub 2021 Apr 30. No abstract available.
- Adolf Helmy M, Magdy Milad L, Hasanin A, Mostafa M. The novel use of diaphragmatic excursion on hospital admission to predict the need for ventilatory support in patients with coronavirus disease 2019. Anaesth Crit Care Pain Med. 2021 Dec;40(6):100976. doi: 10.1016/j.accpm.2021.100976. Epub 2021 Nov 5.
- Roesthuis LH, van der Hoeven JG, van Hees HWH, Schellekens WM, Doorduin J, Heunks LMA. Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support. Ann Intensive Care. 2020 May 29;10(1):67. doi: 10.1186/s13613-020-00684-6.
- Wu JQ, Wang YX, Su D, Shao TH, Ding XX, Sun T, Cui N, Yu ZB. EFFECTS OF LEVOSIMENDAN ON DIAPHRAGMATIC DYSFUNCTION IN PATIENTS WITH SEPSIS. Shock. 2024 Jul 1;62(1):63-68. doi: 10.1097/SHK.0000000000002372. Epub 2024 Apr 8.
- Moser KM, Luchsinger PC, Adamson JS, McMahon SM, Schlueter DP, Spivack M, Weg JG. Respiratory stimulation with intravenous doxapram in respiratory failure. A double-blind co-operative study. N Engl J Med. 1973 Mar 1;288(9):427-31. doi: 10.1056/NEJM197303012880901. No abstract available.
- Eltrabili HH, Hasanin AM, Soliman MS, Lotfy AM, Hamimy WI, Mukhtar AM. Evaluation of Diaphragmatic Ultrasound Indices as Predictors of Successful Liberation From Mechanical Ventilation in Subjects With Abdominal Sepsis. Respir Care. 2019 May;64(5):564-569. doi: 10.4187/respcare.06391. Epub 2019 Jan 22.
- de Waal CG, Hutten GJ, Kraaijenga JV, de Jongh FH, van Kaam AH. Doxapram Treatment and Diaphragmatic Activity in Preterm Infants. Neonatology. 2019;115(1):85-88. doi: 10.1159/000493359. Epub 2018 Oct 23.
- Roesthuis L, van der Hoeven H, Sinderby C, Frenzel T, Ottenheijm C, Brochard L, Doorduin J, Heunks L. Effects of levosimendan on respiratory muscle function in patients weaning from mechanical ventilation. Intensive Care Med. 2019 Oct;45(10):1372-1381. doi: 10.1007/s00134-019-05767-y. Epub 2019 Oct 1.
研究记录日期
研究主要日期
学习开始 (估计的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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