Non Invasive and Invasive Ventilation Post Extubation
Kľúčové slová
Abstrakt
Popis
It is a prospective double-blind study done on total 300 patients. Admitted to King Abdulaziz specialist hospital in Taif, KSA. Between April 2019 and April 2020 with respiratory failure ARDS due to severe lung contusion with these criteria: hypoxic index less than 200, bilateral parenchymatous lung infiltrate, no any acute cardiac insult, failed to maintain SPO2 more than 90% with Non-Invasive Ventilation (NIV) or need of continuous NIV to maintain the previous saturation. This selected ARDS was due to lung contusion which diagnosed by Computerized tomography of the chest following chest trauma. All of them selected to be ventilated for one week or more and only those who showed full criteria of weaning from the ventilator enrolled in our study. Our criteria of weaning include fully conscious patients, hemodynamically stable without any inotropic support, hypoxic index(PAO2/FIO2) more than 200 calculated from the arterial blood gases (ABG), bicarbonate level in arterial blood more than 20 mmol/l, hemoglobin level more than 10 gm%, chest X ray less than one quadrant parenchymatous infiltration in each lung on Murray score of chest Xray, rapid shallow breathing index <105. Patients were randomly allocated in one of three groups each group contain 100 patients. Randomization sequence was created using Excel 2007 (Microsoft, Redmond, WA, USA) with a 1:1 allocation using random block sizes of 2 and 4 by an independent doctor. In this way, sequence generation and type of randomization can be expressed at the same time. Patients of group A extubated and followed our routine protocol of management post extubation which include Nebulization with Ventolin and epinephrine racemic every 8 hours for 48 hours, chest physical therapy (CPT) every 6 hours for 48 hours include clapping percussion with mechanical vibration and suction plus huffing or coughing and postural drainage if there was atelectasis seen by our routine chest X ray. Patients of group B reconnected to mechanical ventilation before extubation for one hour with sedation with midazolam 3-5 milligram/hour intravenous infusion to achieve score 0 or -1on Richmond Agitation - Sedation Scale (RASS). 20 minutes before the end of this hour midazolam infusion discontinued and patients awaked. Patient put on mechanical ventilation (MV) with the following parameters, FIO2 40%, pressure SIMV mode, PEEP 8 cmH2O, Pressure support 15 cmH2O, Respiratory rate 14/min, Peak inspiratory pressure (PIP) of 35 cmH2O. Then patients extubated and followed our previous protocol without the use of NIV.
Termíny
Naposledy overené: | 04/30/2020 |
Prvý príspevok: | 05/19/2020 |
Odhadovaná registrácia bola odoslaná: | 05/19/2020 |
Prvý príspevok: | 05/25/2020 |
Posledná aktualizácia bola odoslaná: | 05/24/2020 |
Posledná aktualizácia bola zverejnená: | 05/26/2020 |
Aktuálny dátum začatia štúdie: | 04/09/2019 |
Odhadovaný dátum dokončenia primárneho okruhu: | 04/01/2020 |
Odhadovaný dátum dokončenia štúdie: | 04/19/2020 |
Stav alebo choroba
Intervencia / liečba
Drug: Midazolam
Device: ventilator
Fáza
Skupiny zbraní
Arm | Intervencia / liečba |
---|---|
Control group extubated and weaning from the ventilator and followed our routine protocol of management post extubation without mechanical ventilation or BIPAP machine | |
Invasive ventilation group reconnected to mechanical ventilator before extubation for one hour with sedation with midazolam 3-5 milligram/hour intravenous infusion to achieve score 0 or -1on Richmond Agitation - Sedation Scale (RASS). 20 minutes before the end of this hour midazolam infusion discontinued and patients awaked. Patient put on mechanical ventilation (MV) with the following parameters, FIO2 40%, pressure SIMV mode, PEEP 8 cmH2O, Pressure support 15 cmH2O, Respiratory rate 14/min, Peak inspiratory pressure (PIP) of 35 cmH2O. Then patients extubated and followed our previous protocol without the use of NIV. | |
non invasive ventilation group following the same previous protocol done after extubation with immediate connection to NIV with BIPAP mode for 1 hour and repeated every 12hours for 48 hours, BIPAP adjusted in our study by FIO2 40%, PEEP 8 cmH2O, Pressure support of 15 cmH2O. |
Kritériá oprávnenosti
Vek vhodný na štúdium | 18 Years To 18 Years |
Pohlavia vhodné na štúdium | All |
Metóda vzorkovania | Probability Sample |
Prijíma zdravých dobrovoľníkov | Áno |
Kritériá | Inclusion Criteria: - respiratory failure ARDS due to severe lung contusion Exclusion Criteria: - post arrest, deeply comatosed patients and children below 18 years |
Výsledok
Primárne výstupné opatrenia
1. number of patients re-intubated within 48 hours and shorten the duration of ICU stay [48 hours]