Brain-injured Patients Extubation Readiness Study

NCT ID: NCT04080440

Last Updated: 2025-09-24

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

RECRUITING

Clinical Phase

NA

Total Enrollment

660 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-09

Study Completion Date

2027-10-13

Brief Summary

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The BIPER study is a stepped wedge cluster randomised clinical trial aiming to decrease extubation failure in critically-ill brain-injured patients with residual impaired consciousness using a simple clinical score.

Detailed Description

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Severe brain-injured patients need mechanical ventilation with tracheal intubation. After treatment of the acute neurological condition, weaning of the mechanical ventilation has to be initiated notably to prevent ventilator associated pneumonia and others complications. Nevertheless, extubation failure is very common in this population due to residual neurological impairment with airway control alteration.

Guidelines about weaning of mechanical ventilation and extubation exclude brain-injured patients with a residual impaired consciousness.

In 2017, a simple and pragmatic extubation readiness clinical score was validated in a prospective observational cohort study of 140 brain injured patients. (Godet et al. Anesthesiology. 2017 Jan;126(1):104-114) In this study, brain injured patients with residual impaired consciousness who succeeded a spontaneous breathing trial were extubated. In multivariate analysis, 4 clinical elements were associated with extubation success. A prediction score was determined using the odds ratio such as followed :

1. Deglutition: 3 points if present
2. Gag reflex: 4 points if present
3. Cough: 4 points if present
4. CRS-R Score, visual item \>2, 3 points if present, 1 point if not

For a cut-off value of 9, extubation failure could be predicted with a sensibility of 84%, a specificity of 75%, a positive predictive value of 89% and a negative predictive value of 66%.

In order to participate, brain-injured patients will have to succeed a spontaneous breathing trial and meet all inclusion criteria, including not being able to obey to command with no or minimal sedation. Using a stepped wedge randomisation process with intensive care units as clusters, patients will be weaned and extubated under usual care or using the extubation readiness clinical score.

The authors' hypothesis is that this clinical score will allow physicians to extubate patients at the right time interval and prevent extubation failure in this frail population.

Conditions

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Mechanical Ventilator Weaning Acute Brain Injury Altered Level of Consciousness Mechanical Ventilation Airway Control

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Stepped wedge, cluster randomised controlled design
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Usual care

Clinicians decide whether to extubate or not following usual care in their ICU ventilator weaning protocol

Group Type ACTIVE_COMPARATOR

Usual Care

Intervention Type PROCEDURE

After treatment of the acute neurological condition, eligibility for a spontaneous breathing trial will be assessed once a day.

In the control group, after a successful spontaneous breathing trial in unconscious patients, the extubation will be achieved according to usual care.

Extubation readiness clinical score

Clinicians decide whether to extubate or not following the extubation readiness clinical score as part of their ICU ventilator weaning protocol

Group Type EXPERIMENTAL

Extubation readiness clinical score

Intervention Type PROCEDURE

After treatment of the acute neurological condition, eligibility for a spontaneous breathing trial will be assessed once a day.

In the intervention group, after a successful spontaneous breathing trial in unconscious patients, the score will be evaluated.

If the score is \> 9, extubation has to be completed.

Interventions

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Extubation readiness clinical score

After treatment of the acute neurological condition, eligibility for a spontaneous breathing trial will be assessed once a day.

In the intervention group, after a successful spontaneous breathing trial in unconscious patients, the score will be evaluated.

If the score is \> 9, extubation has to be completed.

Intervention Type PROCEDURE

Usual Care

After treatment of the acute neurological condition, eligibility for a spontaneous breathing trial will be assessed once a day.

In the control group, after a successful spontaneous breathing trial in unconscious patients, the extubation will be achieved according to usual care.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Acute cerebral lesion with a Glasgow Coma Scale \<13 needing admission in ICU and mechanical ventilation with tracheal intubation for neurological cause : cerebrovascular stroke either ischemic or hemorrhagic including aneurysmal subarachnoid hemorrhage, traumatic brain injury, anoxo ischemic encephalopathy after cardiac arrest or brain tumour
* Mechanical ventilation more than 48 hours
* 18 to 75 years old
* Neurological stability with no intracranial hypertension with minimal sedation
* Glasgow Coma Scale motor response \< 6
* Spontaneous breathing trial succeeded
* First extubation attempt

Exclusion Criteria

* Posterior cranial fossa lesion
* Admission for status epilepticus or central nervous system infection
* Spinal cord injury (tetraplegia or paraplegia)
* Uncontrolled status epilepticus or uncontrolled central nervous system infection
* Care limitation plan
* Chronic respiratory failure defined as ambulatory oxygen therapy or pressure support ventilation and/or proven COPD and/or ambulatory non-invasive CPAP therapy for sleep apnoea syndrome
* More than 3 failed spontaneous breathing trials
* Significant chest trauma (more than 2 broken ribs / broken sternum / with an indication of open thoracic surgery)
* Surgery planned within 7 days
* Tracheotomy or previous extubation outside of the protocol
* Previous compromised upper airway permeability
* Pregnant or breastfeeding woman
* Adult under the protection of the law or without social assurance system
* Inclusion in another clinical study about mechanical ventilation or weaning
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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ANARLF Network

UNKNOWN

Sponsor Role collaborator

Direction Générale de l'Offre de Soin (DGOS)

UNKNOWN

Sponsor Role collaborator

University Hospital, Clermont-Ferrand

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Russell Chabanne

Role: STUDY_DIRECTOR

University Hospital, Clermont-Ferrand

Olivier Vincent

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Grenoble

Florent Gobert

Role: PRINCIPAL_INVESTIGATOR

Hospices Civils de Lyon

Jérôme Morel

Role: PRINCIPAL_INVESTIGATOR

CHU SAINT-ETIENNE

Matthieu Jeannot

Role: PRINCIPAL_INVESTIGATOR

CH VALENCE

Pierre-André Rodié-Talbère

Role: PRINCIPAL_INVESTIGATOR

Nantes University Hospital

Thomas Geeraerts

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Toulouse

Pierre-François Perrigault

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Montpellier

Claire Roger

Role: PRINCIPAL_INVESTIGATOR

CHU Nîmes

Carole Ichai

Role: PRINCIPAL_INVESTIGATOR

CHU NICE

Nicolas Engrand

Role: PRINCIPAL_INVESTIGATOR

Fondation Ophtalmologique Adolphe de Rothschild

Camille Bouisse

Role: PRINCIPAL_INVESTIGATOR

CH de Bourg-en-Bresse

Natalie De Sa

Role: PRINCIPAL_INVESTIGATOR

CHU Lille

Sigismond Lasocki

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Angers

Claire Dahyot-Fizelier

Role: PRINCIPAL_INVESTIGATOR

CHU Poitiers

Yoann Launey

Role: PRINCIPAL_INVESTIGATOR

CHU Rennes

Laurent Petit

Role: PRINCIPAL_INVESTIGATOR

CHU Bordeaux - Réanimation Chirurgicale et traumatologique

Hugues De Courson

Role: PRINCIPAL_INVESTIGATOR

CHU Bordeaux - Réanimation Neurologique

Clément Gakuba

Role: PRINCIPAL_INVESTIGATOR

CHU Caen Normandie

Sophie Kauffmann

Role: PRINCIPAL_INVESTIGATOR

CHU de La Réunion

Locations

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CHU

Angers, , France

Site Status RECRUITING

CHU

Bordeaux, , France

Site Status RECRUITING

CHU

Bordeaux, , France

Site Status RECRUITING

CH

Bourg-en-Bresse, , France

Site Status TERMINATED

CHU

Caen, , France

Site Status RECRUITING

CHU

Clermont-Ferrand, , France

Site Status RECRUITING

CHU

Grenoble, , France

Site Status COMPLETED

CHU

La Réunion, , France

Site Status RECRUITING

CHU

Lille, , France

Site Status RECRUITING

Hospices Civils de Lyon

Lyon, , France

Site Status RECRUITING

APHM

Marseille, , France

Site Status WITHDRAWN

CHU

Montpellier, , France

Site Status RECRUITING

CHU

Nantes, , France

Site Status COMPLETED

Pasteur 2 Hospital - University Hospital

Nice, , France

Site Status TERMINATED

CHU

Nîmes, , France

Site Status RECRUITING

Fondation Ophtalmologique Adolphe de Rothschild

Paris, , France

Site Status RECRUITING

CHU

Poitiers, , France

Site Status RECRUITING

CHU

Rennes, , France

Site Status RECRUITING

CHU

Saint-Etienne, , France

Site Status COMPLETED

CHU

Toulouse, , France

Site Status RECRUITING

CH

Valence, , France

Site Status TERMINATED

Countries

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France

Central Contacts

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Lise Laclautre

Role: CONTACT

+33 4 73 754963

Facility Contacts

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Sigismond Lasocki

Role: primary

Laurent Petit

Role: primary

Hugues De Courson

Role: primary

Clément Gakuba

Role: primary

Russell Chabanne

Role: primary

Sophie Kauffmann

Role: primary

Natalie De Sa

Role: primary

Florent Gobert

Role: primary

Pierre-François Perrigault

Role: primary

Claire Roger

Role: primary

Nicolas Engrand

Role: primary

Claire Dahyot-Fizelier

Role: primary

Yoann Launey

Role: primary

Thomas Geeraerts

Role: primary

References

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Godet T, Chabanne R, Marin J, Kauffmann S, Futier E, Pereira B, Constantin JM. Extubation Failure in Brain-injured Patients: Risk Factors and Development of a Prediction Score in a Preliminary Prospective Cohort Study. Anesthesiology. 2017 Jan;126(1):104-114. doi: 10.1097/ALN.0000000000001379.

Reference Type BACKGROUND
PMID: 27749290 (View on PubMed)

Chabanne R, Godet T, Andanson B, Borrel P, Astier L, Caumon E, Bourguignon N, Laclautre L, Morand D, De Jong A, Futier E, Constantin JM, Pereira B, Jabaudon M. Prevention of extubation failure in neurocritical care patients with residual disorder of consciousness: the Brain-Injured Patients Extubation Readiness (BIPER) study protocol for a stepped-wedge cluster-randomised controlled trial. BMJ Open. 2025 Jul 13;15(7):e104897. doi: 10.1136/bmjopen-2025-104897.

Reference Type DERIVED
PMID: 40659406 (View on PubMed)

Other Identifiers

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2018-A00894-51

Identifier Type: OTHER

Identifier Source: secondary_id

Biper - PhrcIR 2017 Chabanne

Identifier Type: -

Identifier Source: org_study_id

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