Informations générales (source: ClinicalTrials.gov)
Preoxygenation for Tracheal Aspirations in Intensive Care, a Randomized Controlled Trial
Interventional
N/A
Assistance Publique - Hôpitaux de Paris (Voir sur ClinicalTrials)
janvier 2025
décembre 2027
13 septembre 2025
Clearing the airways is a complex phenomenon involving the production of secretions, the
nature of mucus (viscosity, elasticity, stringiness, and adhesiveness), ciliary movement,
and coughing. In intubated and ventilated patients, endotracheal suctioning occur when
the patient is "unable to clear the airways of obstructions hindering the free passage of
air." These suctioning can lead to transient desaturation exacerbated by a decrease in
cardiac output due to increased mean arterial pressure, promoting cardiac arrhythmias. To
minimize these effects, it is recommended to perform additional preoxygenation, by
increasing the fraction of O2 in the air delivered to the patient by the ventilator 2-3
minutes before the procedure. These longstanding recommendations were reiterated in 2022,
based on outdated studies involving systematic suctioning that required disconnecting the
patient from the ventilator.
Currently, suctioning are performed on-demand, based on the patient's congestion status,
either through the endotracheal tube cap or a "closed system." Desaturations have become
infrequent without establishing that additional preoxygenation can prevent them.
Moreover, additional preoxygenation is not without risks. By inducing de-nitrogenation
atelectasis with a loss of lung volume, it can exacerbate pre-existing lung injuries in
the most severe patients. In less severe cases, preoxygenation leads to transient
hyperoxia, with various deleterious effects impacting patient prognosis. Thus, a
short-term risk, such as deep desaturations, must be balanced against a medium-term risk
of hyperoxia and de-nitrogenation.
Etablissements
Critères
Tous
Inclusion Criteria:
- 18 years of age or older
- Hospitalized in ICU, under invasive mechanical ventilation for less than 24 hours
- Information and signature of consent by patient or relative/trusted person, or
emergency inclusion procedure
- 18 years of age or older
- Hospitalized in ICU, under invasive mechanical ventilation for less than 24 hours
- Information and signature of consent by patient or relative/trusted person, or
emergency inclusion procedure
- Patient on ECMO
- Not affiliated to a social security system
- Pregnant
- Under legal protection (curatorship, guardianship or safeguard of justice)
- Patient under AME
- Patient included in another interventional study that may have an impact on the
evaluation criteria of the present study