Oxygen consumption, effort, and weaning in the mechanically ventilated patient in the intensive care unit: The extubate study: A protocol for an observational study

Abstract

Purpose: The spontaneous breathing trial (SBT) is often performed to determine whether the patient can be extubated with a minimal risk of failure. The rapid shallow breathing index (RSBI) is an important parameter used in an SBT. However, weaning failure rates are between 15 and 20 %. Because of the high incidence of extubation failure a search for a better parameter is warranted. The aim of this study is to investigate whether oxygen consumption, pressure-time product, work of breathing and pressure swings predict weaning failure.

Methods: This is a single-center, prospective observational study conducted at the Leiden University Medical Center. Adult patients undergoing an SBT as per the ruling protocol in the LUMC will be included. Measurements of oxygen consumption, pressure-time product, work of breathing and pressure swings will be continuously recorded during 10 min prior, during and 10 min after the SBT. Data collection will not interfere with clinical decision making. The primary outcome is the ability of these parameters to predict extubation success or failure.

Discussion: Patient enrollment started in January 2024 and inclusions are expected to be complete in January 2026. Patient's risk and burden are minimal. We hypothesize that patients who fail extubation will have higher absolute baseline efforts but will not have the potential to increase those efforts when subjected to an SBT.

Trial registration: The study is retrospectively registered at ClinicalTrials.gov under identifier NCT06391424, submitted on 2024-04-30.

Keywords: Esophageal pressure; Intensive care unit; Mechanical ventilation; Patient effort; Spontaneous breathing trial; Weaning.