Clinical trial NCT06926231: Non-medicinal Technique and Dyspnea in Weaning Patients
Official title: Impact of a Non-medicinal Technique Medical Hypnosis on Perceived Dyspnea in Difficult Ventilatory Weaning Patients: a Multicenter Randomized Controlled Trial.
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Difficult Mechanical Ventilation Weaning
Spontaneous Breathing Trial
Dyspnea
Keywords: difficult mechanical ventilation weaning
dyspnea
mechanical ventilation
spontaneous breathing trial
hypnosis
Lead sponsor: Hospices Civils de Lyon
Sponsor class: OTHER
First posted: 2025-04-13
Enrollment: 82
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: This is a randomized, controlled, multicenter, open-label, category 2, parallel-arm study of efficacy and superiority.

The target population are patients hospitalized in the intensive care unit (ICU), ventilated with invasive mechanical ventilation for 24 hours or more and having failed a spontaneous breathing trial (SBT, i.e. weaning test of invasive mechanical ventilation \[IMV\]).

The primary objective is to evaluate the efficacy of medical hypnosis in reducing dyspnea experienced before the SBT in patients identified as difficult to wean in the ICU, compared with the protocolized standard of care.

The primary outcome is the mean value of the daily visual analog scale (VAS) of dyspnea, self-assessed by the patient, measured immediately after the hypnosis session (before SBT) from Day-0 to Day-7 or until extubation. In the control group, the daily value (from D0 to D7 or extubation) of the self-assessed dyspnea VAS will be measured immediately before SBT.

The protocol will be divided into two arms: a control arm in which standard of care practices regarding the daily SBT will be protocolized, and an interventional arm in which patients will receive protocolized medical hypnosis before the daily SBT in addition to the protocolized standard of care. The intervention (hypnosis or control) will be performed daily for 7 days (or until extubation, if applicable). The primary outcome will be assessed daily over the same period.


Eligibility criteria: Inclusion Criteria:

* Adult patient
* hospitalized in the intensive care unit
* receiving invasive mechanical ventilation for 24 hours or more.
* who has failed at least one spontaneous breathing trial

Exclusion Criteria:

* Patient already intubated during current ICU stay (including transfer from another ICU unit), with successful extubation during stay.
* Tracheostomized patient or patient with a short-term tracheostomy project.
* Patients with chronic neuromuscular pathologies (myopathy, amyotrophic lateral sclerosis, multi-system atrophy, non-exhaustive list).
* Patient no longer eligible for SBT at time of inclusion (hemodynamic, neurological or respiratory criterion)
* Psychiatric pathology identified in the medical record, diagnosed by a psychiatrist and for which medication is prescribed (bipolar disorder, schizophrenia, anxiety-depressive disorder, non-exhaustive list).
* Recent brain injury, within \< 3 months (stroke, cardiopulmonary arrest with neurological prognosis, non-exhaustive list) objectivated by medical imagery.
* Cognitive impairment or delirium associated with resuscitation, identified by a positive CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) test (dynamic parameter).
* Ocular Glasgow score lower than 4/4 and motor response lower than response to simple commands.
* Delirium tremens with Cushman score \> 7 (dynamic parameter).
* Language barrier, patient who does not use French in everyday life.
* Deaf or hearing-impaired patients.
* Re-sedated patient following the failed SBT the day before inclusion.
* Pregnant, parturient or breastfeeding women, objectified by a negative pregnancy test in women of childbearing age.
* Patient for whom a limitation of therapeutics has been decided, including the absence of a re-intubation project.
* Patient whose consent cannot be obtained (directly or in front of a relative or witness).
* Patient already included in the same study or in another study sharing the same primary outcome.
* Patient deprived of liberty by judicial or administrative decision.
* Patient of legal age under legal protection (guardianship, curators).
* Patient not affiliated to a social security system or beneficiary of a similar system.
* Patient participating in another interventional research study with an exclusion period still in effect at pre-inclusion.

Primary outcomes:
measure: Mean value of self-reported daily visual analog scale of dyspnea after the intervention or the control strategy
timeFrame: Immediately after the hypnosis session (before SBT) from day 0 to day 7 or until extubation. In the control group, the daily value (from day 0 to day 7 or extubation) of self-reported VAS of dyspnea will be measured immediately before SBT.
Secondary outcomes:
measure: Mean MV-RDOS score (Mechanical Ventilation-Respiratory Distress Observation Scale) after the intervention or the control strategy
timeFrame: Immediately after the hypnosis session (before SBT) from day 0 to day 7 or until extubation. In the control group, the daily value (from day 0 to day 7 or extubation) of MV-RDOS will be measured immediately before SBT.
measure: Mean VAS of dyspnea at the end of the SBT
timeFrame: Immediately at the end of the daily protocolized SBT, which is performed every day from day 0 to day 7 or until extubation in all patients. Measured daily at the end of the SBT, from day 0 to day 7 or until extubation. Up to 28 days
measure: Mean MV-RDOS at the end of SBT
timeFrame: Immediately at the end of the daily protocolized SBT, which is performed every day from day 0 to day 7 or until extubation in all patients.
measure: Mean VAS of anxiety at the end of SBT
timeFrame: Immediately at the end of the daily protocolized SBT, which is performed every day from day 0 to day 7 or until extubation in all patients.
measure: Mean VAS of pain at the end of SBT
timeFrame: Immediately at the end of the daily protocolized SBT, which is performed every day from Day 0 to Day 7 or until extubation in all patients. The outcome measure consists in the mean value of the daily measures collected during this period.
measure: Respiratory physiology
timeFrame: Value of respiratory rate and SpO2, measured immediately at the beginning of the SBT, and worst value observed during the daily SBT, between inclusion and day 7 or extubation
measure: Hemodynamic status
timeFrame: Value of heart rate and mean arterial pressure, measured immediately at the beginning of the SBT, and worst value observed during the daily SBT, between inclusion and day 7 or extubation
measure: Quality of applied intervention and control strategies
timeFrame: Up to Day 7
measure: Feasibility: enrolment
timeFrame: At the end of the study recruitment.
measure: Feasibility: hypnosis training
timeFrame: At the end of the recruitment.
measure: Safety: neurological impact of strategies
timeFrame: The RASS value will be assessed continuously during the duration of the intervention in Gp1 or during the protocolized observation period in Gp2, and its highest value will be reported. It will be reported daily in each group, between inclusion and D7.
measure: Invasive mechanical ventilation weaning
timeFrame: Measured at day 28
measure: Reintubation
timeFrame: Measured at day 28
measure: ICU length of stay
timeFrame: through study completion, up to 28 days
Other outcomes:
Locations:
city: Bourg-en-Bresse
country: France
facility: Hôpital de Fleyriat - Centre hospitalier de Bourg-en-Bresse - Réanimation Soins continus
city: Clermont Ferrand
country: France
facility: CHU Clermont Ferrand - Hôpital Gabriel Montpied - Médecine Intensive Réanimation
city: La Tronche
country: France
facility: CHU Grenoble Alpes - Hôpital Michallon - Médecine Intensive Réanimation
city: Lyon
country: France
facility: Hospices Civils de Lyon - Hôpital de la Croix Rousse - Médecine Intensive Réanimation
city: Pierre Bénite
country: France
facility: Hospices Civils de Lyon - Hôpital Lyon Sud - Réanimation Polyvalente
Study officials:
References: