Mechanical Ventilation in Brain-injured Patients

NCT ID: NCT01885507

Last Updated: 2015-02-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

560 participants

Study Classification

OBSERVATIONAL

Study Start Date

2013-07-31

Study Completion Date

2014-09-30

Brief Summary

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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

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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

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Brain-injury Stroke Subarachnoid Haemorrhage Traumatic Brain Injury Structural Coma

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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Control phase (before)

Process of care and outcomes before the educational program

No interventions assigned to this group

Training phase (after)

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

Pass recommendations on ventilation factors and extubation

Intervention Type OTHER

* 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

Interventions

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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

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult patients (traumatic brain-injured, subarachnoid hemorrhage, stroke or other)
* Brain injury (Glasgow Coma Scale ≤ 12 associated with at least one anomaly related to an acute process on head tomographic tomodensitometry
* mechanical ventilation for more than 24 hours

Exclusion Criteria

* early decision to withdraw care (taken in the first 24 hours in ICU),
* death in the first 24 hours
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Nantes University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Karim Asehnoune, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Nantes University Hospital

Locations

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Angers University Hospital

Angers, , France

Site Status

Beaujon Hospital

Beaujon, , France

Site Status

Brest University Hospital

Brest, , France

Site Status

Caen University Hospital

Caen, , France

Site Status

Clermont-Ferrand University Hospital

Clermont-Ferrand, , France

Site Status

Henri Mondor University Hospital

Créteil, , France

Site Status

Grenoble University Hospital

Grenoble, , France

Site Status

Bicêtre University Hospital

Le Kremlin-Bicêtre, , France

Site Status

Marseille University Hospital

Marseille, , France

Site Status

Montpellier University Hospital

Montpellier, , France

Site Status

Nantes University Hospital

Nantes, , France

Site Status

Nice University Hospital

Nice, , France

Site Status

Nimes University Hospital

Nîmes, , France

Site Status

Georges Pompidou European Hospital

Paris, , France

Site Status

Poitiers University Hospital

Poitiers, , France

Site Status

Rennes University Hospital

Rennes, , France

Site Status

Rouen University Hospital

Rouen, , France

Site Status

Nantes University Hospital

Saint-Herblain, , France

Site Status

Toulouse University Hospital - Purpan

Toulouse, , France

Site Status

Toulouse University Hospital - Rangueil

Toulouse, , France

Site Status

Tours Univeristy Hospital - Neurosurgery ICU

Tours, , France

Site Status

Tours University Hospital - Neurotrauma ICU

Tours, , France

Site Status

Countries

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France

References

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Asehnoune K, Mrozek S, Perrigault PF, Seguin P, Dahyot-Fizelier C, Lasocki S, Pujol A, Martin M, Chabanne R, Muller L, Hanouz JL, Hammad E, Rozec B, Kerforne T, Ichai C, Cinotti R, Geeraerts T, Elaroussi D, Pelosi P, Jaber S, Dalichampt M, Feuillet F, Sebille V, Roquilly A; BI-VILI study group. A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project. Intensive Care Med. 2017 Jul;43(7):957-970. doi: 10.1007/s00134-017-4764-6. Epub 2017 Mar 18.

Reference Type DERIVED
PMID: 28315940 (View on PubMed)

Other Identifiers

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RC13_0127

Identifier Type: -

Identifier Source: org_study_id

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