Mechanical Ventilation in Brain-injured Patients "BI-VILI"

Completed

Phase N/A Results N/A

Trial Description

Protective ventilation (association of a tidal volume < 8 ml/kg with a positive end expiratory pressure) is poorly used in severe brain-injured patients. Moreover, a systematic approach to extubation may decrease the rate of extubation failure and enhance outcomes of brain-injured patients.
We hypothesized that medical education and implementation of an evidence-base care bundle associating protective ventilation and systemic approach to extubation can reduce the duration of mechanical ventilation in brain-injured patients.

Detailed Description

A before/after study design will be used. The before period (control phase) will consisted of all consecutive patients with severe brain-injury who were admitted to the participating ICUs.
During the interphase, all physicians, residents, physiotherapists and nurses will receive a formal training for the processes and procedures related to the 2 point bundle: protective ventilation and systematic approach to extubation (according to recommendation for the use of tidal volume < 7 ml/kg and of a positive expiratory pressure = 6 to 8 cmH20 (centimeter of water) and extubation as soon as ventilatory weaning is associated with a glasgow coma scale equal or above 10 and cought).
The after period consisted of all consecutive severe brain-injured patients admitted to the participating ICUs after the formal training.

Conditions

Interventions

  • Pass recommendations on ventilation factors and extubation Other
    Intervention Desc: the use of tidal volume < 7 ml/kg and of a positive expiratory pressure = 6 to 8 cmH20 (centimeter of water) extubation as soon as ventilatory weaning is associated with a glasgow coma scale equal or above 10 and cough
    ARM 1: Kind: Experimental
    Label: Training phase (after)
    Description: Process of care and outcomes after the educational program which recommends: the use of tidal volume < 7 ml/kg and of a positive expiratory pressure = 6 to 8 cmH20 (centimeter of water) extubation as soon as ventilatory weaning is associated with a glasgow coma scale equal or above 10 and cough

Trial Design

  • Observation: Case Control
  • Perspective: Prospective
  • Sampling: Non-Probability Sample

Trial Population

Structural coma.

Outcomes

Type Measure Time Frame Safety Issue
Primary Mechanical ventilatory free days Day-90 No
Secondary Mortality day-90 No
Secondary In-ICU mortality 90 days No
Secondary Duration of mechanical ventilation 90 days No
Secondary ICU free days at day 90 day 90 No
Secondary Acute respiratory distress syndrome / acute lung injury day-90 No
Secondary Hospital acquired pneumonia day-90 No
Secondary Blood gaz day-5 No
Secondary Intracranial pressure day-5 No
Secondary Glasgow outcome scale day-90 No
Secondary Extubation failure day-90 No
Secondary Ventilatory setting day-5 No

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