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

Capital Medical University

Status: Not yet enrolling

Conditions: Difficult-to-Wean Patients

Treatments: Procedure: EIT-guided chest physiotherapy; Procedure: chest physiotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT06677099

2022-030

Details and patient eligibility

About

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.

Enrollment: 80 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 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mechanical ventilation more than 96 hours before randomization, are meted the preconditions for the machine to be withdrawn, and at least have one failed attempt to withdraw the ventilator (re-need ventilator support within 48 hours after extubation),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.

Exclusion criteria

• 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.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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80 participants in 2 patient groups

Control group

Experimental group

Description:

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 to the assessment, internal guidelines, the patient's tolerance, education level, and patient's preference prior to the randomization. All CPT sessions were performed by the same physiotherapist to avoid potential bias.

Treatment:

Procedure: chest physiotherapy

EIT-guided group

Experimental group

Description:

EIT-guided group: Similar to the patients in the Control group, the CPT techniques were predefined for the patients according to the assessment prior to the randomization. For each CPT session, EIT measurement was conducted and the images were used to guide the CPT treatments. The uses of EIT to guide individual treatments are briefly described as follows.

Treatment:

Procedure: EIT-guided chest physiotherapy