None listed
Conditions
Brief summary
This study has been designed to assess whether a ventilation strategy which maintains alveolar patency by the application of recruitment manoeuvres and elevated PEEP and which limits airway pressures by allowing permissive hypercapnia will reduce lung injury as assessed by serum cytokine levels.
Interventions
Initial setup: After randomization the patient will receive a stepwise recruitment manoeuvre followed by a decrimental positive end expiratory pressure (PEEP) trial commencing at 25cmH20 to determine the optimal PEEP for that patient. Plateau airway pressures will then be reduced until either the tidal volume is < 4ml/Kg, a PaCO2 > 60mmHg in the presence of a plateau pressure under 30cmH20 or significant acidosis are encountered (pH<7.15).
Ongoing ventilator management: Recruitment manoeuvres
Initial setup: After randomization the patient will receive a stepwise recruitment manoeuvre followed by a decrimental positive end expiratory pressure (PEEP) trial commencing at 25cmH20 to determine the optimal PEEP for that patient. Plateau airway pressures will then be reduced until either the tidal volume is < 4ml/Kg, a PaCO2 > 60mmHg in the presence of a plateau pressure under 30cmH20 or significant acidosis are encountered (pH<7.15). Ongoing ventilator management: Recruitment manoeuvres will be performed regularly (up to 4 times per day) until the SaO2 >/=95% on FiO2 =40% for 12 hours or FiO2 >/=35% for 1 hour. In addition the arterial pH goal for the intervention patients: 7.15 < pH < 7.45 until the SaO2 >/=95% on FiO2 =40% for 12 hours or FiO2 =35% for 1 hour.
Sponsors
Intensive Care Unit, Alfred Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
15 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
(1) Diagnosis of Acute Respiratory Distress Syndrome based on the American-European Consensus Conference criteria.
Exclusion criteria
Patients were excluded if they had chest trauma, an intercostal catheter with air leak, a pneumothorax on chest x-ray, bronchospasm on auscultation, raised intracranial pressure, mean arterial pressure less than or equal to 60 mmHg, significant arrhythmias or were ventilated for longer than 72 hours.
Outcome results
None listed