One-Hour Positive Pressure Ventilation After a T-Piece Spontaneous Breathing Trial

Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorHospital do Coracao

About this trial

This is a randomized, open, multicenter, pragmatic, adaptive clinical trial with intention-to-treat analysis. The study will compare two weaning strategies from mechanical ventilation in critically ill patients admitted to intensive care units, with more than 72 hours of mechanical ventilation and with a successful spontaneous breathing trial on T-piece. Immediately after a successful spontaneous breathing trial, eligible patients will be randomized into 2 groups that will be treated according to one of the following interventions:

1. One-hour positive pressure ventilation: as soon as the success of the spontaneous breathing trial is confirmed, the patient is submitted to mechanical ventilation for 1 hour using the previous ventilatory parameters and, afterwards, extubated. 2. Immediate extubation: the patient is extubated immediately after the success of the spontaneous breathing trial.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Patients aged > 18 years.

Admitted to the intensive care unit (surgical or medical).

With endotracheal intubation.

Mechanical ventilation for more than 72 hours.

Disqualifiers

Patients unable to obey commands.

With non-planned extubation.

Neuromuscular disease and cervical spinal cord injury.

Tracheostomy.

Trial design

Design model

Parallel

Treatments tested in this trial

  • One-hour positive pressure ventilation

    Other intervention

    As soon as the success of the spontaneous breathing trial is confirmed, the patient is submitted to mechanical ventilation for 1 hour using the previous ventilatory parameters and, afterwards, extubated.

  • Immediate extubation

    Other intervention

    The patient is extubated immediately after the success of the spontaneous breathing trial.

Treatment groups

4,000 Participants
are divided into 2 treatment groups
Group A: One-hour positive pressure ventilationExperimental treatment 1 intervention
Group B: Immediate extubationActive comparator 1 intervention

Trial outcomes

Primary outcomes

1

Number of Participants With Extubation Failure Within 7 Days

Extubation failure is defined as a composite endpoint of reintubation or death within 7 days after randomization.

Time frame
7 days (from randomization through Day 7 after randomization)

Secondary outcomes

1

Ventilator-Free Days Through Day 28

Ventilator-free days are defined as the number of days alive and free from invasive mechanical ventilation from randomization through Day 28 after randomization. If a patient dies before day 28, the ventilator-free days will be counted as zero. If a patient is reintubated and returns to mechanical ventilation and later is extubated again and remains in unassisted breathing until day 28, the ventilator-free days will be counted from the end of the last period of assisted breathing until day 28. An invasive mechanical ventilation period of less than 24 hours for surgical purposes will count as 1 ventilator-free day. Patients discharged from the hospital in unassisted breathing before 28 days will be considered alive and free from mechanical ventilation for the remaining days up to 28 days. Patients transferred to another hospital or healthcare unit will be followed up until day 28 to assess this outcome.

Time frame
28 days (from randomization through Day 28 after randomization)
2

Hospital-Free Days Through Day 28

Hospital-free days are defined as the number of days alive and out of the hospital from randomization through Day 28 after randomization. If a patient dies before day 28, the hospital-free days will be counted as zero. Patients discharged from the hospital in unassisted breathing before 28 days will be considered alive and free from hospital for the remaining days up to 28 days. Patients transferred to another hospital or healthcare unit will be followed through day 28 to ascertain this outcome.

Time frame
28 days (from randomization through Day 28 after randomization)
3

Number of Participants Who Died Within 28 Days

All-cause mortality from randomization through day 28

Time frame
28 days (from randomization through Day 28 after randomization)

Other outcomes

1

Ventilatory Support-Free Days Through Day 28

Ventilatory support-free days are defined as the number of days alive and free from any ventilatory support (invasive or noninvasive) from randomization through day 28. Any use of invasive mechanical ventilation for any duration during a calendar day will count as 1 day with ventilatory support (i.e., not free). Use of noninvasive ventilatory support (noninvasive ventilation or high-flow nasal cannula) for ≥6 hours in any calendar day will count as 1 day with ventilatory support. Participants who die before day 28 will be assigned 0 ventilatory support-free days. If reintubation occurs and the participant later achieves unassisted spontaneous breathing again, ventilatory support-free days will be counted from the end of the last assisted-breathing period through day 28, provided the participant remains alive and free from ventilatory support.

Time frame
28 days (from randomization through Day 28 after randomization)
2

Number of Participants With Extubation Failure Within 2 Days

Extubation failure is defined as a composite endpoint of reintubation or death within 2 days after randomization

Time frame
2 days (from randomization through Day 2 after randomization)
3

Number of Participants With Death or Reintubation Within 28 Days

Composite endpoint of reintubation or death within 28 days after randomization

Time frame
28 days (from randomization through Day 28 after randomization)
4

Intensive Care Unit-Free Days Through Day 28

ICU-free days are defined as the number of days alive and out of the intensive care unit from randomization through day 28. If a patient dies before day 28, the ICU-free days will be counted as zero. Patients discharged from the hospital in unassisted breathing before 28 days will be considered as alive and free from ICU for the remaining days up to 28 days. Patients transferred to another hospital or healthcare unit will be followed up until day 28 to assess this outcome.

Time frame
28 days (from randomization through Day 28 after randomization)

Locations

This trial has no locations.

Sponsors and contacts

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