adjustment of parameters on mechanical ventilation deviceroutine plan of weaning and Conventional Chest Physiotherapy
adjustment of parameters on mechanical ventilation device: adjust the parameters of the mode of training on mechanical ventilation according the group of patients
routine plan of weaning and Conventional Chest Physiotherapy: Chest Physiotherapy including: ▪ Postural Drainage ▪ Manual techniques for airway clearance (percussion, vibration, shaking) Adding to range of passive to active movements of the limbs
Study summary
This study will be conducted to compare the effectiveness of progressive inspiratory flow trigger sensitivity rising versus stepwise pressure support reduction as ventilator-based inspiratory muscle training methods on weaning and extubation success in mechanically ventilated patients with respiratory failure.
Eligibility
Sex
ALL
Min age
40 Years
Max age
55 Years
Healthy volunteers
No
Inclusion Criteria:
* Acute respiratory failure patients in the ICU are receiving MV for 48 h or more in a controlled mode.
* Their ages will range from 40 to 55 years old, and both sexes will be included.
* Conscious and oriented patients with a Glasgow coma score ≥13 (≥9T).
* Alertness score with a Richmond Agitation-Sedation Scale (RASS) will be from 0 to -1.
* All patients in this study must be hemodynamically and medically stable.
* Patients must be able to trigger spontaneous breaths on the ventilator but couldn't generate maximum inspiratory pressure more than -15 mbar.
Exclusion Criteria:
* Persistent hemodynamic instability as life-threatening conditions or comorbidities interfere with and compromise weaning, like cardiac arrhythmia, pericardial effusion, congestive heart failure, or acute coronary syndrome.
* Severe breathlessness when spontaneously breathing.
* Any progressive neuromuscular disease, such as myopathy or neuropathy, that would interfere with responding to inspiratory muscle training due to inadequate training performance of the inspiratory muscle.
* Spinal cord injury.
* Skeletal pathology (scoliosis, flail chest, spinal instrumentation) that would seriously impair the movement of the chest wall and ribs.
* Patients in a coma or under heavy sedation (RASS ≤ -2) and with respiratory muscle paralysis.
* High peak airway pressure (barotrauma), high PEEP \>10, or active pneumothorax.
Primary outcome measure(s)
Spontaneous breathing trial (SBT) — From initiation of the first SBT until successful extubation, up to 48 hours documenting the frequency (total number) of spontaneous breathing trials for each patient until successful extubation
Burn's Wean Assessment Score — baseline (Day 1, prior to intervention) and immediately before initiation of successful SBT Calculate the percentage of the total score to indicate the extent of improvement and the probable readiness for weaning (in %). The 26-item checklist assigns 1 point for "yes" responses, with a total score up to 26. Scores below 17 (65%) suggest insufficient readiness for weaning, while scores ≥ 17 indicate probable readiness for weaning.
Duration of MV — from randomization to successful unassisted breathing, up to 48 hours defined as the time from study randomization to successful unassisted breathing (in days)
weaning success rate — Within 48 hours following extubation absence of ventilatory support 48 hours after discontinuation of MV. Inability to tolerate or pass SBT or to be liberated from invasive ventilatory support indicates weaning failure (in %).
Extubation success rate — Within 72 hours following extubation defined as the proportion of subjects who did not die and were not re-intubated 48-72 hours after the scheduled extubation. The inability to sustain spontaneous breathing after removal of the endotracheal tube, requiring either reintubation or the use of NIV within this specified period, indicates extubation failure (in %).
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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