Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 16;25(1):481.
doi: 10.1186/s13063-024-08297-1.

Effect of lung volume preservation during spontaneous breathing trial on successful extubation in patients receiving mechanical ventilation: protocol for a multicenter clinical trial

Carles Subirà  1   2   3   4 , Gina Rognoni  5   6   7 , Herbert Baquerizo  5   6   7 , Carolina García  8 , Sara Cabañes  9 , Maria de la Torre  10 , Beatriz Quevedo  11 , Cristina Pedrós  12 , Ana I Tizón  13 , Natalia Murillo  14 , Laura Parro  15 , Fernando Eiras  16 , Gemma Rialp  17 , Susana Altaba  18 , Alejandro González-Castro  19 , Andrés F Pacheco  20 , Pablo Bayoumi  21 , Norma Gómez-Medrano  22 , Imma Vallverdú  23 , Áurea Higón  24 , María D Navarro  25 , Alirio Falcón  26 , Elena Keough  27 , David Arizo  28 , Juan F Martínez  29 , Núria Durán  30 , Raquel Rodríguez  31   32   33 , Melinda R Popoviciu-Koborzan  34 , Isabel Guerrero  35 , Pablo Concha  36 , Patricia Barral  37 , Montserrat Batlle  5   31   6 , Sílvia Cano  5   6 , Silvia Garcia-Castrillon  5   6 , Xavier Andorrà  5   6 , Yenifher Tua  5   6 , Anna Arnau  38   39   40 , Rafael Fernández  5   31   6
Affiliations

Effect of lung volume preservation during spontaneous breathing trial on successful extubation in patients receiving mechanical ventilation: protocol for a multicenter clinical trial

Carles Subirà et al. Trials. .

Abstract

Background: In standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation.

Methods: This multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization.

Discussion: We aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients.

Trial registration: The Research Ethics Committee (CEIm) of the Fundació Unió Catalana d'Hospitals approved the study (CEI 22/67 and 23/26). Registered at ClinicalTrials.gov in August 2023. Identifier: NCT05526053.

Keywords: Extubation; Lung ultrasound; Mechanical ventilation; Spontaneous breathing trial; Weaning.

PubMed Disclaimer

Conflict of interest statement

The principal investigator (CS) received an award for this research project from the Fundación Española del Enfermo Crítico FEEC. GR received the Best Research Project award from the Societat Catalana de Medicina Intensiva Crítica (SOCMIC) (€1500).

References

    1. Peñuelas O, Frutos-Vivar F, Muriel A, Mancebo J, García-Jiménez A, de Pablo R, et al. Mechanical ventilation in Spain, 1998–2016: Epidemiology and outcomes. Med Intensiva (Engl Ed) 2021;45(1):3–13. doi: 10.1016/j.medin.2020.04.024. - DOI - PubMed
    1. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033–1056. doi: 10.1183/09031936.00010206. - DOI - PubMed
    1. Fernandez R, Subira C, Frutos-Vivar F, Rialp G, Laborda C, Masclans JR, et al. High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial. Ann Intensive Care. 2017;7(1):47. doi: 10.1186/s13613-017-0270-9. - DOI - PMC - PubMed
    1. Hernández G, Vaquero C, Colinas L, Cuena R, González P, Canabal A, et al. Effect of postextubation high-flownasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients a randomized clinical trial. JAMA. 2016;316(15):1565–1574. doi: 10.1001/jama.2016.14194. - DOI - PubMed
    1. Fernandez MM, González-Castro A, Magret M, Bouza MT, Ibañez M, García C, et al. Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial. Intensive Care Med. 2017;43(11):1660–1667. doi: 10.1007/s00134-017-4911-0. - DOI - PubMed

Publication types

MeSH terms

Associated data