New Integrated Weaning Indexes (NIWIs)

This study has been completed.
Sponsor:
Collaborator:
Tehran University of Medical Sciences
Information provided by (Responsible Party):
Amir Vahedian-Azimi, Baqiyatallah Medical Sciences University
ClinicalTrials.gov Identifier:
NCT01779297
First received: January 23, 2013
Last updated: January 28, 2013
Last verified: January 2013
  Purpose

The purpose of this study is to determine whether introducing the new weaning indexes can predict better than traditional ones?


Condition
Mechanical Ventilation Weaning

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: New Integrated Weaning Indexes From Mechanical Ventilation: A Prospective Clinical Trial

Further study details as provided by Baqiyatallah Medical Sciences University:

Primary Outcome Measures:
  • Better accuracy in predicting weaning outcome [ Time Frame: Four years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Adequate prognosis [ Time Frame: Four years ] [ Designated as safety issue: No ]

    The following measurements were taken for weaning indexes:

    1. RSBI
    2. NIF
    3. P0.1
    4. CROP
    5. IWI
    6. PaO2: PALVO2 ration (PPR)
    7. PaO2:FiO2 ratio (PFR)
    8. RR
    9. VT
    10. MV
    11. C Dynamic
    12. C Static
    13. Pimax
    14. PaO2
    15. PaCO2
    16. FiO2
    17. SaO2
    18. Respiratory index
    19. Formula one [(PPR)/ (RSBI*FiO2)]
    20. Formula two [(PPR)/ (RSBI*FiO2*P0.1)]
    21. Formula three [(PPR)*(NIF)/ (RSBI*FiO2)]
    22. Formula four [(PPR)*(NIF)/ (RSBI*FiO2*P0.1)]
    23. Formula five [(NIF)/ (P0.1)]
    24. Formula six [(SaO2)/ ((P (A-a) O2)*RSBI*FiO2)]
    25. Formula seven [(SaO2)/ ((P (A-a) O2)*RSBI*FiO2*P0.1)]
    26. Formula eight [(SaO2*NIF)/ ((P (A-a) O2)*RSBI*FiO2)]
    27. Formula nine [(SaO2*NIF)/ ((P (A-a) O2)*RSBI*FiO2*P0.1)]
    28. Formula ten [(SaO2)/ ((P (A-a) O2)*P0.1)] These are newly proposed indexes, used in some hospitals in Iran.


Enrollment: 1175
Study Start Date: October 2007
Study Completion Date: December 2012
Primary Completion Date: January 2008 (Final data collection date for primary outcome measure)
Detailed Description:

The study was divided into two parts: First, the threshold values of the indexes that discriminated best between successful weaning and weaning failure were determined in training set (n = 208). Second, the accuracy of each index was scrutinized prospectively in an additional group of patients (prospective-validation data set, n = 967). One thousand one hundred and seventy-five patients who were on mechanical ventilation for more than 24 hours were evaluated.Informed consent was obtained from each patient, whenever possible, or from the patient's next of kin. The samples were selected using a simple random sampling method in which the entry number of eligible patients was considered to be the sampling ID number. Using Random Allocation Software (RAS), random numbers were generated to select the study participant.

The ventilators used were Evita XL and Evita 4 edition (Draeger, Lubeck, Germany).

According to a protocol that have introduced in two studies, the protocol established. All of the mechanically ventilated patients undergoing assessment for extubation undergo a daily SBT if predetermined eligibility criteria for weaning are met . According to this protocol, sedation would be discontinued before evaluation of weaning. Patients who meet these criteria are initially placed on SBT (continuous positive airway pressure of 5 mmHg, FiO2≤0.4) for 3 minutes to obtain weaning parameters. If the Oxygen saturation is ≥ 92% on pulse oximetry with FiO2≤0.4 and RSBI <104 breaths/minute/L, patients are continued on the SBT for 30 to 120 minutes. All clinical and ventilator parameters are monitored closely for signs of respiratory distress (respiratory rate > 30 breaths/minute, SaO2< 90%, heart rate > 140 breaths/minute, or a sustained increase or decrease of heart rate of >20%, blood pressure>200 mm Hg or <80 mm Hg, and agitation, diaphoresis, or anxiety). At the end of the SBT, the RSBI is measured again, ABG is obtained, and the predetermined values are calculated and measured. The decision to return to mechanical ventilation made by the two subspecialists in pulmonary and lung diseases, who were chief supervisor of both ICU in two cities (who were completely blind to the study and the results of the indexes evaluated), based on airway competence (cough, sputum production, neurologic status, level of consciousness, and maximal inspiratory pressure). Patients who remain extubated at 48 hours are classified as having had a successful extubation. Baseline demographics, initial diagnosis, and pre-extubation clinical, ventilator, laboratory, and radiographic data are collected for each patient.

To assess the prognostic value of new indices, receiver operator characteristic (ROC) curves was drawn for each formula in addition for other conventional criteria used in this area. For each ROC curve analysis, sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, diagnostic accuracy, likelihood ratio of a positive test (LR+) and the likelihood ratio of a negative test (LR-), probability for weaning success when test is positive and probability for weaning success when test is negative of the indexes were used to predict the weaning outcome in the prospective-validation data set.

Hanley and McNeil method was used to calculate the area under curve (AUC) for each formula and then the methods developed by the same authors were used to compare these AUCs. Bayes' theorem was used to compute the weaning outcome the probability for weaning success when test is positive and negative (post-test probability) in the prospective-validation data set to assess the perform

  Eligibility

Ages Eligible for Study:   18 Years to 90 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population

One thousand one hundred and seventy-five patients who were on mechanical ventilation for more than 24 hours were evaluated.

Criteria

Inclusion Criteria:

  • Patients (both males and females) more than 24 hours in mechanical ventilation in weaning process.

Exclusion Criteria:

  1. Hypercapnic respiratory failure attributable to COPD exacerbation or post-respiratory arrest;
  2. underlying moderate to severe obstructive airways disease, defined as forced expiratory volume in 1 second of < 50% of predicted value, or baseline PaCO2 > 50 mmHg,
  3. concurrent neurological and neuromuscular or drug intoxication contributing to respiratory failure; and finally younger than 18 years of age
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01779297

Locations
Iran, Islamic Republic of
Shariati hospital, Mousavi Hospital, Valiasr hospital
Tehran & Zanjan, Iran, Islamic Republic of
Sponsors and Collaborators
Baqiyatallah Medical Sciences University
Tehran University of Medical Sciences
  More Information

No publications provided

Responsible Party: Amir Vahedian-Azimi, Senior Intensivist Nurse, Phd Candidate in Nursing, Baqiyatallah Medical Sciences University
ClinicalTrials.gov Identifier: NCT01779297     History of Changes
Other Study ID Numbers: BMSU & TUMS
Study First Received: January 23, 2013
Last Updated: January 28, 2013
Health Authority: Iran: Ethics Committee
Iran: Ministry of Health

Keywords provided by Baqiyatallah Medical Sciences University:
new integrative weaning indexes
mechanical ventilation
ICU

ClinicalTrials.gov processed this record on September 18, 2014