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.

Hemodynamic Impact of the Spontaneous Ventilation Test in Patients at Risk of Weaning Pulmonary Oedema

Weaning-induced pulmonary edema (WIPE) from the ventilator is a frequent cause of extubation failure or delay, which prolongs the duration of invasive mechanical ventilation and the associated morbidity and mortality. WIPE is a very frequent cause of extubation failure in at-risk patients. A spontaneous breathing trial (SBT) is performed before extubating a patient, either by disconnecting the patient from the ventilator (T-piece SBT) or by setting the ventilator to spontaneous breathing mode with pressure support at 7 cm H2O and zero positive end-expiratory pressure (PS-ZEEP SBT). There is currently no recommendation regarding which SBT modality should be used, particularly in patients at risk of WIPE. The hemodynamic changes induced by the SBT can lead to WIPE, which typically develops within minutes of the SBT onset. The hypothesis being tested is that, by altering intrathoracic pressure during the patient's inspiration (negative pressure), the T-piece SBT leads to a greater increase in left ventricular filling pressures compared to the PS-ZEEP SBT.

Ultrasound Evaluation of Cardiac Function During Spontaneous Breathing Trials

The goal of this clinical trial is to evaluate the evolution of a cardiac ultrasound index (E/E') during 3 spontaneous breathing trials in Intensive Care Unit (ICU) adults (over 18 years) patients at risk for weaning failure. The main objective is to find out which spontaneous breathing trial is the least demanding in terms of heart work. Investigators will compare 3 consecutive spontaneous breathing trials in a random order to see if one is superior to the others. Participants will not have to perform any specific procedure apart from breathing without respiratory support during the spontaneous breathing trial. During these trials, the investigator will perform cardiac ultrasound measurements.