Clinical Research Directory

Detecting Early Weaning-induced Pulmonary Oedema Using Lung Impedance Negative Trend During Spontaneous Breathing Trials

Critically ill patients who require a breathing machine are routinely assessed with a spontaneous breathing trial (SBT) to determine if they can safely breathe on their own. If the trial fails, the breathing machine must be continued. One common cause is weaning-induced pulmonary oedema (WIPO), in which the heart cannot handle the increased workload during spontaneous breathing, causing fluid to accumulate in the lungs. Although several markers can suggest WIPO, it is often diagnosed after the SBT has already failed. Earlier recognition could allow clinicians to treat the condition promptly, improving the success rate of subsequent trials. This study will examine whether electrical impedance tomography (EIT)-a bedside monitor that tracks how air moves in the lungs-can help identify WIPO earlier. It will focus on how lung aeration changes in the first minutes of the trial and whether combining EIT with standard clinical measurements improves early prediction of SBT outcome and identification of WIPO. Study procedures will take place during routine SBTs and are mostly non-invasive. Participants will undergo EIT monitoring, heart and lung ultrasound, ventilator measurements, and blood tests. Clinical care remains entirely according to the ICU team. Participants will be followed for up to 28 days.

Randomized Study of the pdSTIM™ System in Failure to Wean Mechanically Ventilated Patients

This prospective, multi-center, randomized, controlled clinical trial is being conducted to evaluate the safety and efficacy of the pdSTIM System to facilitate weaning from mechanical ventilation through phrenic nerve stimulation. Potential subjects who are on mechanical ventilation for at least four days and have failed at least one weaning attempt will be considered for the study. Those enrolled will be randomized in a 1:1 manner between the treatment group that is standard of care with the pdSTIM System and a Control group, which is standard of care alone.

High-Flow Tracheal Oxygen During Spontaneous Breathing Trial

The purpose of this study is to find out whether high-flow tracheal oxygen (HFTO) delivered at flows greater than 60 L/min can increase end-expiratory lung volume (EELV) in intubated patients during a spontaneous breathing trial (SBT). Weaning from mechanical ventilation can be difficult, especially in patients at higher risk of failure. During an SBT, losing positive end-expiratory pressure (PEEP) can cause the lungs to lose volume and make breathing harder by increasing the work of breathing (WOB). HFTO may help reduce the work of breathing, but previous studies using flows of 30-60 L/min did not consistently show an increase in EELV. Higher flows may create more airway pressure. Therefore, the main question this study is trying to answer is: In intubated patients during an SBT, does HFTO at flows greater than 60 L/min increase EELV? The hypothesis is that HFTO at flows above 60 L/min will increase EELV during the SBT.

Standardization of IMT Dosage (UTIT) in Mechanical Ventilation.

Respiratory muscle weakness prolongs mechanical ventilation (MV) and delays weaning. Currently, there is no standardized dosage for Inspiratory Muscle Training (IMT) in the ICU. This study aims to define an optimal IMT dosage using a new metric called "Total Inspiratory Work Unit" (UTIT), which integrates intensity, repetition, and frequency. The study compares three daily dosage regimens (1,000 UTIT, 2,000 UTIT, and 3,000 UTIT) adjusted daily based on the patient's Negative Inspiratory Force (NIF). The goal is to determine the optimal dose-response relationship for improving inspiratory muscle strength (PiMax) and reducing the duration of mechanical ventilation.

Progressive Pressure Support Reduction as Inspiratory Muscle Endurance Training in Mechanically Ventilated Patients

Mechanical ventilation causes rapid diaphragm muscle atrophy, detectable within 18 hours of ventilator support, which is a major contributor to weaning failure and prolonged ICU stay. This randomized controlled trial tests whether a physiotherapist-guided inspiratory endurance training program - achieved by progressively reducing pressure support (PS) levels on the ventilator - can preserve or improve inspiratory muscle strength and diaphragm structure in critically ill adults on mechanical ventilation, compared to standard ICU care. Participants will be randomly assigned to one of two groups. The intervention group will receive twice-daily training sessions (weekdays only) in which the physiotherapist gradually reduces PS by up to 50% of the baseline level, causing the patient to breathe with greater muscular effort - equivalent to progressive endurance exercise for the diaphragm. The control group will receive standard weaning care as directed by the attending intensivist. The primary outcome is maximal inspiratory pressure (PImax) at day 7. Secondary outcomes include diaphragm thickening fraction measured by ultrasound, time to successful extubation, weaning success rate, and mortality. All measurements are performed by the ICU physician (blinded to group allocation) using airway occlusion maneuvers recorded on the ventilator and diaphragm ultrasound, following a standardized protocol.

Factors Associated With Late Extubation in Postoperative Patients in the Surgical Intensive Care Unit

Timely removal of a breathing tube after surgery is an important part of recovery for patients admitted to the intensive care unit (ICU). In some cases, patients may require longer use of mechanical ventilation, which can be associated with longer hospital stays and a higher risk of complications. The purpose of this study is to examine clinical factors that may be associated with delayed removal of breathing tubes in postoperative ICU patients. This study will use information that has already been routinely collected during standard medical care, such as patient characteristics, breathing-related measurements, fluid balance, and laboratory test results. This is a retrospective observational study and does not involve any additional treatments, procedures, or changes to routine clinical care. By analyzing these existing data, the study aims to improve understanding of factors related to extubation timing and support future efforts to enhance postoperative ICU care.

High Flow Tracheal Oxygen for Weaning of Tracheostomized Patients

In this pilot randomized controlled trial (RCT), the investigators aim to explore the feasibility of conducting a powered RCT that examines the efficacy and safety of high flow tracheal oxygen (HFTO) in weaning critically ill tracheostomy patients from mechanical ventilation. Objective of the study 1. To assess the feasibility of conducting a larger RCT as primary objective. 2. To explore the effect of using HFTO in mechanically ventilated tracheostomized critically ill patients on ventilator-free days (VFD) compared to standard of care method using tracheal mask (TM) as secondary objective.

Phenotype-Guided Weaning in Mechanically Ventilated Patients With Chronic Comorbidities

The goal of this clinical trial is to learn whether a phenotype-guided weaning strategy can help adults with chronic comorbidities be liberated from invasive mechanical ventilation earlier. It will also learn about the safety of this strategy. The main questions it aims to answer are: * Does the phenotype-guided weaning strategy increase the number of ventilator-free days within 28 days after enrollment? * Does the strategy improve the process and success of ventilator liberation? * What safety events occur when this strategy is used? Researchers will compare the phenotype-guided weaning strategy with standard care in mechanically ventilated patients with chronic cardiovascular, cerebrovascular, or respiratory comorbidities. In the intervention period, participants will receive a protocolized ventilator weaning pathway. This pathway includes assisted ventilation transition, daily weaning readiness screening, a 0 cmH2O continuous positive airway pressure test, spontaneous breathing trial, extubation assessment, and post-extubation respiratory support when appropriate. The phenotype-guided part of the strategy is mainly used for participants who fail a spontaneous breathing trial or have difficult weaning. These participants will undergo structured ABCDE screening to identify the main phenotype or mechanism of weaning failure: * A: airway or lung dysfunction * B: brain dysfunction, including delirium, anxiety, agitation, or impaired consciousness * C: cardiac dysfunction * D: diaphragm or respiratory muscle dysfunction * E: endocrine, metabolic, or nutritional problems Based on the identified phenotype, clinicians will provide targeted assessment and treatment. Participants will be followed for ventilator-free days through day 28 and for clinical outcomes through day 90.

The Use of Diaphragmatic Ultrasonography in Mechanical Ventilation Weaning Decision in COPD Patient

The aim of this study is to evaluate the use of diaphragmatic ultrasonography in taking mechanical ventilation weaning decision and predicting outcome in Chronic obstructive pulmonary disease patient. Primary outcome: • Number of patients with failed weaning trial and need reintubation. Secondary outcomes: * Time till extubation trial. * Ventilation free days after extubation less or more than 48h . * Number of Intensive care unit discharges. * Sensitivity and specificity of diaphragmatic assessment as a predictor of weaning.

Feasibility Study to Compare Two Ventilatory Modes for Mechanical Ventilation Weaning

We hypothesize that the ventilatory mode Bilevel Positive Airway Pressure without any synchronization (BIPAPasynchro) may facilitate the weaning process of patients intubated with acute hypoxiemic respiratory failure (AHRF) by obviating the problem of patient-ventilator asynchrony. In order to prove this hypothesis a large randomized controlled study should be perfromed comparing BIPAPasynchro versus pressure support ventilation (PSV), the most widely used ventilatory mode during the weaning process. In order to do so, a feasibility trial to demonstrate the ICU personnel can effectively use a non-standard ventilatory mode should be first performed. The objective of our study is, thus, to demonstrate the feasibility of using BIPAasynchro in the Lausanne Adult ICU.

Autonomic Modulation in Patients Undergoing Assisted Mechanical Ventilation: Comparison Between PAV+ and PSV

The aim of the study is to investigate autonomic modulation in terms of heart rate variability (i.e., HRV) in patients undergoing assisted mechanical ventilation in PSV mode, compared to patients assisted in PAV+ mode. The hypothesis is that the greater patient-ventilator synchrony of the latter mode may represent an advantage in reducing the imbalance of autonomic modulation.