Electrical Impedance Tomography in Guiding Early and Precise Rehabilitation of Patients with Difficult Ventilator Weaning

Официальное название

Electrical Impedance Tomography in Guiding Early and Precise Rehabilitation of Patients with Difficult Ventilator Weaning:A Single-cente Randomised Controlled Trial

Обзор

Diaphragm dysfunction, ineffective chest wall and respiratory muscle function are frequently observed in critically ill patients with difficult weaning from mechanical ventilation(MV).It is the leading cause of retention of airway secretions and insufficient airway clearance.Thechest physiotherapy (CPT) of critically ill patients can reduce secretion retention. We designed a protocol to investigate the feasibility and efficacy of CPT guided by electrical impedance tomography (EIT) in Difficult-to-Wean patients.

Вмешательства

• Процедура chest physiotherapy
  Two sessions of CPT (morning and afternoon, 20 minutes each) were conducted. The CPT session consisted of modified postural drainage, assisted cough technique , positive expiratory pressure and chest percussion, vibration. The appointed therapist performed pulmonary auscultation and thoracic palpation to assess the status of pulmonary ventilation and secretion retention, and whether the patient's cough ability can complete effective airway clearance. Individualized program was formed according t
• Процедура EIT-guided chest physiotherapy
  EIT-guided modified postural drainage combined with vibrations and chest percussion: tidal variation images in EIT reveals heterogeneously ventilated regions. Physiotherapist identified such regions at the bedside and instructed the patient to take the appropriate drainage position, so that the poorly ventilated regions became gravity non-dependent regions. Subsequently, the physiotherapist put her hands on the poorly ventilated area with a vibratory force. A compressive pressure was produced by

Первичные конечные точки

• peak expiratory flow [Срок оценки: All data will be recorded at the baseline (T1), 14 days (T2) and 28 days (T3)]

Вторичные конечные точки (6)

• The cumulative incidence of successful weaning by Day 30 [Срок оценки: from admission to discharge, assessed up to 1 day]
• Maximum inspiratory pressure [Срок оценки: All data will be recorded at the baseline (T1), 14 days (T2) and 28 days (T3)]
• Diaphragm thickening rate [Срок оценки: All data will be recorded at the baseline (T1), 14 days (T2) and 28 days (T3)]
• Diaphragmatic excursion [Срок оценки: All data will be recorded at the baseline (T1), 14 days (T2) and 28 days (T3)]
• Length of ICU stay [Срок оценки: from admission to discharge, assessed up to 1 day]
• Cumulative incidence for death before successful weaning [Срок оценки: from admission to discharge, assessed up to 1 day]

Критерии участия

Критерии включения

• mechanical ventilation patients who are ≥18 years old, are received to invasive mechanical ventilation more than 96 hours before randomization, are meted the preconditions for the machine to be withdrawn, and at least have one failed attempt to withdraw the ventilator (re-need ventilator support within 48 hours after extubation),
• willing to participate in the study and sign the informed consentsent.

Критерии исключения

• Malignant arrhythmia or acute myocardial ischemia
• Pneumothorax, pulmonary bulla and barotrauma and other lung diseases
• Hemorrhagic disease or abnormal coagulation mechanism with bleeding tendency
• Chest skin trauma
• Pulmonary hypertension and pulmonary embolism
• With a permanent or temporary pacemaker
• There is malignant tumor
• Present and previous history of neuromuscular diseases affecting respiratory muscle
• Participated in another clinical study related to mechanical ventilation withdrawal
• Can not cooperate with the study for any reason or the researcher thinks that it is not suitable to be included in this experiment.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Четверное слепое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Публикации

• Wang H, Xi J, Jiang H. Randomized clinical study of electrical impedance tomography-guided chest physiotherapy in difficult-to-wean patients: study protocol. PeerJ. 2025 Aug 4;13:e19727. doi: 10.7717/peerj.19727. eCollection 2025. PMID 40777077

Идентификаторы

NCT: NCT06677099 · 2022-030

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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