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  • Canadian Critical Care Trials Group
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Programs

Principal Investigator(s)

Status

Completed

SENIOR Trial- Screening Elderly PatieNts For InclusiOn in a Weaning Trial

Screening Elderly PatieNts For InclusiOn in a Weaning Trial: The SENIOR Trial

Background: During weaning the work of breathing is transferred from the ventilator back to the patient. Approximately 40% of the time on ventilators is spent weaning. Studies support the use of screening protocols and tests of patient's ability to breathe spontaneously (SBTs) to identify weaning candidates. Our work demonstrates that once daily screening is the current standard of care. The conduct of daily ward rounds and once daily screening in ICUs is poorly aligned with the rapidly changing clinical status of critically ill patients. With respiratory therapists (RTs) in Canadian intensive care units (ICUs), a significant opportunity exists to screen patients more often, conduct more SBTs, and reduce the time spent on ventilators and in the ICU. Only one mechanical ventilation trial has focused on the elderly and no trial has evaluated weaning outcomes in the elderly and very elderly which may be influenced by the presence of comorbidities, frailty, malnutrition and treatment limitations.

Methods: We propose to conduct a pilot randomized trial in 100 elderly (> 65 years) critically ill adults comparing ‘once daily’ screening to ‘at least twice daily’ screening in 8 adult ICUs. In the proposed trial, we will (i) evaluate our ability to recruit elderly (> 65 years) critically ill patients into a weaning trial and (ii) assess whether protocols can be adhered to similarly between elderly (65 to 80 years) and very elderly (>80 years) trial participants. Moreover, we will also address generalizability issues in the conduct of mechanical ventilation research by evaluating potential biases associated with exclusion criteria and consent between elderly and very elderly patients and obtain preliminary estimates of differences in important clinical outcomes between elderly and very elderly participants.

Conclusion: The SENIOR Trial will be the first weaning trial specifically conducted in the elderly. Information gained from the SENIOR pilot trial will inform design of a larger planned weaning trial. This trial will provide valuable and needed information to better inform discussions with elderly, critically ill patients and their SDMs regarding weaning outcomes.

Co-Investigators

Maureen Meade, Peter Dodek, Francois Lamontagne, Sangeeta Mehta, Andrew Seely, Eddy Fan, Laurent Brochard, Jan Friedrich, Lori Hand, Michelle Kho, Pierre Aslanian, Deborah Cook.