Effect of High Flow Oxygen Therapy in Spontaneous Breathing Trial on Weaning in Mechanical Ventilated Patients

A Randomized Trial of High Flow Oxygen Therapy in Spontaneous Breathing Trial on Weaning in Mechanical Ventilated Patients.

This clinical trial is aimed to show a spontaneous breathing trial using high flow oxygen therapy may lower weaning failure rate and reintubation rate than using T-piece.

We project to test the effect of high flow oxygen therapy in spontaneous breathing trial on weaning in mechanical ventilated patients. Patients will be randomly assigned to undergo a spontaneous breathing trial in one of two ways: with a T-piece therapy or with high flow oxygen therapy. Primary end-points are rate of weaning failure and rate of reintubation within 48 hr of extubation. Weaning failure is defined as failed to spontaneous breathing trial or reintubation within 48 hr of extubation. Secondary end-points are ICU mortality, in-hospital mortality, ICU length of stay, time to reintubation after extubation. Study sample was calculated to detect ability of high flow oxygen therapy to reduce weaning failure from 42 to 15 percent, at two-tailed alpha error of 5% and power of 85% and 98 patients are needed in each arm.

Inclusion Criteria:

• Adult patients aged 18 years or more, both gender

• Receiving endotracheal intubation and mechanical ventilation for more than 12 hours

• Recovery from the precipitating illness

• Weaning readiness according to the following criteria :

  1. Respiratory criteria :

     1. PaO2:FIO2 >150 with FIO2 ≤0.4, PEEP <8 cm H2O
     2. Arterial pH >7.35
     3. Rapid shallow breathing index (RSBI) < 105
     4. Maximum inspiratory pressure (MIP) < -20 cm H20

  2. Clinical criteria :

     1. Absence of electrocardiographic signs of myocardial ischemia
     2. No vasoactive drugs, or vital signs are stable with using vasoactive drugs
     3. Heart rate <140/min,
     4. Hemoglobin >8 g/dL
     5. Temperature <38°C
     6. No need for sedatives, or mental status are stable with sedatives
     7. Presence of respiratory stimulus, and appropriate spontaneous cough
     8. Absence of excessive tracheobronchial secretions

Exclusion Criteria:

• Tracheostomy status
• Decision to stop life-supportive therapies before enrollment