Lung Ultrasound Assisting Weaning in Difficult-to-wean Patients

Summary

Daily lung ultrasound can help weaning from mechanical ventilation in difficult-to-wean adult patients. In this randomized trial, standardized lung ultrasound will be performed daily asssociated with standardized interventions aiming to decrease the total time in mechanical ventilation.

Conditions

• Difficult-to-wean Adult Patients

Interventions

OTHER

Abolish Lung Sliding

If there is no lung sliding, the patient will be promptly evaluated for pneumothorax or mainstream intubation.

OTHER

Normal Lung Ultrasound

If the patient fails the spontaneous breathing trial and the lung ultrasound examination is normal - researchers will investigate venous thrombosis (deep vein thrombosis and/or pulmonary embolism) and rule out reversible airway obstruction. If the patient has the previous diagnosis of COPD, non invasive mechanical ventilation is indicated for facilitate weaning.

OTHER

Pulmonary Interstitial Syndrome

If lung ultrasound shows "B pattern" - cardiogenic pulmonary edema will be differentiated from Acute Respiratory Distress Syndrome (ARDS). If cardiogenic edema is a possibility, diuretics will be administrated (at least 40 mg of furosemide) or ultrafiltration will be performed. The main target is a negative fluid balance of, at least, 1000 ml before the next spontaneous breathing trial. Another possibility is to titrate vasodilators (at least a 20% reduction in the systolic blood pressure) before the next spontaneous breathing trial.

OTHER

Asymmetrical Lung Ultrasound

If lung ultrasound shows asymmetrical findings, the occurence of new or uncontrolled infection (pulmonary or extrapulmonary) will be investigated.

OTHER

Simple Pleural Effusion

If the patient has pleural effusion without ultrasonographic signs of complications (any hyperechoic pattern or complex septated pattern), researchers will administrate diuretics (at least 40 mg of furosemide in 24 hours) or increase ultrafiltration - to achieve a negative fluid balance of, at least, 1000 ml before the next spontaneous breathing trial. Another possibility is to perform pleural drainage.

OTHER

Complex Pleural Effusion

If there is pleural effusion with hyperechoic or septated pattern, another image exam will be performed and evaluated by the surgical team.

Sponsors & Collaborators

• Hospital Moinhos de Vento

  collaborator OTHER

• Federal University of Rio Grande do Sul

  collaborator OTHER

• Hospital Ernesto Dornelles

  lead OTHER

Principal Investigators

• Felippe L Dexheimer, MD · Hospital Ernesto Dornelles

• Cassiano Teixeira, MD, PhD · Hospital Moinhos de Vento

• Paulo R Dalcin, MD, PhD · Federal University of Rio Grande do Sul

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2012-10-31

Primary Completion

2013-12-31

Completion

2014-06-30

Countries

• Brazil

Study Locations