Clinical trial

Postextubation Use of Noninvasive Respiratory Support in Severely Obese Patients

Recruiting now · Not applicable · 2 countries · Registry ID NCT05918575

Recruiting nowNot applicableInterventional

What this study is about

Around 20% of the obese patients with higher body mass index (BMI) who are taken off the breathing tube and breathing machine (ventilator) end up needing it back to support breathing. The re-application of breathing tube is associated with poor outcomes, including high risk of pneumonia, longer hospital stays, and death. The purpose of this study is to assess if prophylactic use of noninvasive breathing support after removing the breathing tube lowers the chance of needing the breathing tube again.

A promising-looking record is not the same as confirmed eligibility. The study team must review the full criteria and current recruitment status.

Basic eligibility

Age18 Years to Not listed

SexAll

Healthy volunteersNot accepted

ConditionObesity, Morbid, Extubation Failure

Full registry criteria

Inclusion Criteria: 1. Adult, age ≥ 18 years old 2. Receiving invasive mechanical ventilation for ≥24 hours 3. BMI ≥40 kg/m2 4. Undergoing planned extubation per treating team 5. Arterial pH ≥7.35 or venous pH ≥ 7.31 within 30 mins of spontaneous breathing trial (SBT) Exclusion Criteria: 1. Pregnant 2. Use of extra-corporeal membrane oxygenation 3. Chronic tracheostomy in place 4. Unplanned or accidental extubation 5. Terminal/compassionate extubation 6. Contraindication to NIV use 7. Intubated because of an acute exacerbation of COPD 8. Underlying neuromuscular disease 9. No reintubation requested by patient/family 10. Documented/known history of chronic hypercapnic respiratory failure on home NIV (including bilevel PAP). 11. Enrolled in any other outcome study 12. Treating clinician feels that HFNC or NIV are either mandatory or contraindicated for a given patient

Treatments and study arms

Noninvasive ventilation alternating with high flow nasal cannula

Device

A total of 24 hours of prophylactic respiratory support will be provided using NIV alternating with HFNC with total NIV usage of 16 hours and HFNC usage of 8 hours.

High flow nasal cannula

Device

A total of 24 hours of prophylactic respiratory support will be provided using HFNC alone.

Primary outcomes

Treatment failure defined by use of rescue respiratory support for acute respiratory failure in the first 72 hours after planned extubation72 hours

Rescue respiratory support is defined as reintubation, use of rescue NIV or HFNC use