NCT01885507

Mechanical Ventilation in Brain-injured Patients

Duration of Mechanical Ventilation and Mortality Among Brain-injured Patients - a Before-after Evaluation of a Quality Improvement Project

• Status: Completed
• Phase: —
• Study type: Observational
• Enrollment: 560 (actual)
• Sponsor: Nantes University Hospital · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

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

• Brain-injury
• Stroke
• Subarachnoid Haemorrhage
• Traumatic Brain Injury
• Structural Coma

Interventions

Type	Name	Description
OTHER	Pass recommendations on ventilation factors and extubation	* 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

Timeline

• Start date: 2013-07-01
• Primary completion: 2014-09-01
• Completion: 2014-09-01
• First posted: 2013-06-25
• Last updated: 2015-02-23

Locations

22 sites across 1 country: France