Comparison of Physiological Effects of Two High-Flow Tracheal Oxygen Versus T-Piece During Spontaneous Breathing Trials

NCT ID: NCT06816706

Last Updated: 2025-03-21

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

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-03-01

Study Completion Date

2025-12-30

Brief Summary

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Spontaneous breathing trials (SBT) are essential for assessing extubation tolerance, yet optimal approaches are debated. High-flow nasal oxygen offers benefits like precise oxygen delivery, flow-related positive end-expiratory pressure generation and improved lung function. While high-flow tracheal oxygen can also be used as an SBT method, it has reduced physiological effects due to bypassing the upper airway with a more open circuit. To enhance this limitation, investigators developed a modified high-flow tracheal oxygen tube with a smaller expiratory end diameter to increase expiratory resistance and airway pressure. This is a prospective randomized crossover study that aims to compare the physiological effects of standard and modified high-flow tracheal oxygen versus T-piece during SBT.

Detailed Description

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A spontaneous breathing trial (SBT) is a crucial step in the weaning and extubation process for assessing extubation tolerance. However, the optimal approach for conducting SBTs remains a topic of debate.

High-flow nasal oxygen has been shown to provide several physiological benefits, including precise control of the fraction of inspired oxygen, generation of flow-related positive end-expiratory pressure, increased end-expiratory lung volume, improved oxygenation, and enhanced carbon dioxide elimination. High-flow oxygen therapy can also be applied via an artificial airway as high-flow tracheal oxygen. Previous studies have identified this therapy as a potential alternative for SBTs. However, compared to high-flow nasal oxygen, high-flow tracheal oxygen exhibits significantly diminished physiological effects due to the bypassing of the narrow nasopharynx, glottis, and upper airway as well as a more open circuit.

To address this limitation, the investigators have developed a modified high-flow tracheal oxygen tube with a reduced expiratory end tube diameter. This modification aims to create higher expiratory resistance and airway pressure, thereby simulating the physiological effects of HFNC. This study is a prospective randomized crossover physiological study designed to compare the effects of standard and modified high-flow tracheal oxygen versus T-piece during spontaneous breathing trials. Key physiological parameters will be assessed, including airway pressure, end-expiratory lung volume, vital signs, oxygenation, and respiratory workload.

Conditions

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Critical Care Oxygen Therapy Mechanical Ventilation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Modified high flow tracheal oxygen-40L/min

Modified high-flow tracheal oxygen with a flow rate of 40L/min will be performed in mechanically ventilated patients undergoing spontaneous breathing trials.

Group Type EXPERIMENTAL

Modified high flow tracheal oxygen-40L/min

Intervention Type PROCEDURE

Modified high-flow tracheal oxygen with a flow rate of 40L/min will be performed.

Standard high flow tracheal oxygen-40L/min

Standard high-flow tracheal oxygen with a flow rate of 40L/min will be performed in mechanically ventilated patients undergoing spontaneous breathing trials.

Group Type EXPERIMENTAL

Standard high flow tracheal oxygen-40L/min

Intervention Type PROCEDURE

Standard high-flow tracheal oxygen with a flow rate of 40 L/min will be performed.

T-piece

T-piece will be performed in mechanically ventilated patients undergoing spontaneous breathing trials.

Group Type EXPERIMENTAL

T-piece

Intervention Type PROCEDURE

T-piece will be performed.

Modified high-flow tracheal oxygen-60L/min

Modified high-flow tracheal oxygen with a flow rate of 60L/min will be performed in mechanically ventilated patients undergoing spontaneous breathing trials.

Group Type EXPERIMENTAL

Modified high-flow tracheal oxygen-60L/min

Intervention Type PROCEDURE

Modified high-flow tracheal oxygen with a flow rate of 60L/min will be performed.

Standard high-flow tracheal oxygen-60L/min

Standard high-flow tracheal oxygen with a flow rate of 60L/min will be performed in mechanically ventilated patients undergoing spontaneous breathing trials.

Group Type EXPERIMENTAL

Standard high-flow tracheal oxygen-60 L/min

Intervention Type PROCEDURE

Standard high-flow tracheal oxygen with a flow rate of 60 L/min will be performed.

Interventions

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Modified high flow tracheal oxygen-40L/min

Modified high-flow tracheal oxygen with a flow rate of 40L/min will be performed.

Intervention Type PROCEDURE

Standard high flow tracheal oxygen-40L/min

Standard high-flow tracheal oxygen with a flow rate of 40 L/min will be performed.

Intervention Type PROCEDURE

T-piece

T-piece will be performed.

Intervention Type PROCEDURE

Modified high-flow tracheal oxygen-60L/min

Modified high-flow tracheal oxygen with a flow rate of 60L/min will be performed.

Intervention Type PROCEDURE

Standard high-flow tracheal oxygen-60 L/min

Standard high-flow tracheal oxygen with a flow rate of 60 L/min will be performed.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Mechanical ventilation for more than 24 hours
2. Considered by the physicians for the readiness to wean and ready for spontaneous breathing trials

Exclusion Criteria

1. Age younger than 18 years old
2. Pregnancy
3. Hemodynamic instability (mean arterial pressure \<60 mmHg, heart rate \>140 or \<60 bpm)
4. Respiratory and oxygenation instability (respiratory rate \> 35bpm or oxygen saturation measured by pulse oximetry \<90%)
5. Neuromuscular diseases or phrenic nerve injury
6. Recent trauma or surgery to the trachea, esophagus, neck, chest, or stomach
7. Pneumothorax or placement of a chest drainage
8. Contraindication to electrical impedance tomography (EIT) (implantable defibrillator)
9. Anticipating withdrawal of life support
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jian-Xin Zhou

OTHER

Sponsor Role lead

Responsible Party

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Jian-Xin Zhou

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Jian-Xin Zhou, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Capital Medical University

Locations

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Beijing Shijitan Hospital

Beijing, Beijing Municipality, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Jian-Xin Zhou, MD, PhD

Role: CONTACT

8610 6392 6666

Shan-Shan Xu, MD

Role: CONTACT

8618501219133

Facility Contacts

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Jian-Xin Zhou, MD, PhD

Role: primary

8610 6392 6666

Shan-Shan Xu, MD

Role: backup

8618501219133

References

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Xu SS, Zhang RZ, An X, Miao MY, Wang YF, Li HL, Zhou JX. Physiological effects of high-flow oxygen via endotracheal tube versus T-piece strategies during spontaneous breathing trials: a study protocol and statistical analysis for a single-centre randomised crossover study. BMJ Open. 2025 Sep 16;15(9):e105360. doi: 10.1136/bmjopen-2025-105360.

Reference Type DERIVED
PMID: 40962338 (View on PubMed)

Other Identifiers

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IIT2024-157-002

Identifier Type: -

Identifier Source: org_study_id

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