{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T21:51:57Z","timestamp":1782856317288,"version":"3.54.5"},"reference-count":49,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T00:00:00Z","timestamp":1689120000000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005261","name":"Centre Hospitalier R\u00e9gional Universitaire de Montpellier","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100005261","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,6,28]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Readiness to be freed from ventilatory support can be evaluated by spontaneous breathing trial (SBT) assessing the patient\u2019s ability to sustain respiratory effort after extubation. Current SBT practices are heterogenous and there are few physiological studies on the topic. The objective of this study is to assess which SBT best reproduces inspiratory effort to breathe after extubation depending on the patient\u2019s illness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This will be a multicentre randomised cross-over physiological study, in a large population, in the era of modern intensive care units using last generation modern ventilators. Each included patient will perform three 15-minute SBTs in a random order: pressure support ventilation (PSV) level of 7 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O with positive end expiratory pressure (PEEP) level of 0 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O, PSV 0 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O with PEEP 0 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O and T-piece trial. A rest period of baseline state ventilation will be observed between the SBTs (10 min) and before extubation (30 min). Primary outcome will be the inspiratory muscle effort, reflected by pressure time product per minute (PTPmin). This will be calculated from oesophageal pressure measurements at baseline state, before and after each SBT and 20 min after extubation. Secondary outcomes will be PTPmin at 24 hours and 48 hours after extubation, changes in physiological variables and respiratory parameters at each step, postextubation respiratory management and the rate of successful extubation. One hundred patients with at least 24 hours of invasive mechanical ventilation will be analysed, divided into five categories of critical illness: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease and miscellaneous (pneumonia, sepsis, heart disease).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study project was approved by the appropriate ethics committee (2019-A01063-54, Comit\u00e9 de Protection des Personnes TOURS - R\u00e9gion Centre - Ouest 1, France). Informed consent is required, for all patients or surrogate in case of inability to give consent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04222569\">NCT04222569<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-070931","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T10:36:36Z","timestamp":1689158196000},"page":"e070931","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct04222569","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04222569","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04222569","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Mathieu","family":"Capdevila","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France"},{"name":"Department of critical care patient acquired muscle weakness, INSERM U1046, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"De Jong","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France"},{"name":"Department of critical care patient acquired muscle weakness, INSERM U1046, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yassir","family":"Aarab","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelie","family":"Vonarb","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Molinari","sequence":"additional","affiliation":[{"name":"Department of Statistics, University Hospital Centre Montpellier, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9791-8779","authenticated-orcid":false,"given":"Xavier","family":"Capdevila","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Medicine A, University Hospital Centre Montpellier, Montpellier, France"},{"name":"Montpellier NeuroSciences Institute, INSERM U1051, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Brochard","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St.Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7257-8069","authenticated-orcid":false,"given":"Samir","family":"Jaber","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France"},{"name":"Department of critical care patient acquired muscle weakness, INSERM U1046, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,12]]},"reference":[{"key":"2025121513325310000_13.7.e070931.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e7586","article-title":"SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials","volume":"346","author":"Chan","year":"2013","journal-title":"BMJ"},{"key":"2025121513325310000_13.7.e070931.2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201208-1523CI"},{"key":"2025121513325310000_13.7.e070931.3","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1164\/rccm.201607-1338OC","article-title":"Effort to breathe with various spontaneous breathing trial techniques. 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