None listed
Conditions
Brief summary
To determine if recruitment manoeuvres are more effective than standard care in resolving acute lung collapse on chest x-ray.
Interventions
Patients in the treatment group will be positioned in side lying with the affected side uppermost and ventilated in pressure controlled mode with a pressure control level of 15 cmH2O (up to 18) and will receive a step-wise recruitment treatment protocol where positive end expiratory pressure (PEEP) is increased incrementally from 10 (or other baseline) to 20, 30cm H20 every 2 minutes and then decreased to PEEP of 15cmH2O. This will be maintained for the remainder of the day with one short re-rec
Patients in the treatment group will be positioned in side lying with the affected side uppermost and ventilated in pressure controlled mode with a pressure control level of 15 cmH2O (up to 18) and will receive a step-wise recruitment treatment protocol where positive end expiratory pressure (PEEP) is increased incrementally from 10 (or other baseline) to 20, 30cm H20 every 2 minutes and then decreased to PEEP of 15cmH2O. This will be maintained for the remainder of the day with one short re-recruitment maneuver (to max pressure 40cmH2O for 2 minutes). 4 hours prior to reassessment the patient will be returned to pre-existing ventilatory settings and previous PEEP levels. Patients will receive an staircase recruitment manoeuver (SRM) every day for the duration of mechanical ventilation.
Sponsors
Alfred Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
16 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
Patients will be eligible for inclusion is they are mechanically ventilated, have an arterial line for blood gas analyses and blood pressure monitoring, a central venous catheter and are diagnosed with chest x-ray collapse/atelectasis on the morning of data collection by the intensive care unit (ICU) consultant or senior registrar on call. No new lines will be placed for study inclusion.
Exclusion criteria
Patients will be excluded if they have an ICC (intercostals catheter) in situ with current or previous air leak, a pneumothorax on chest x-ray, acute respiratory distress syndrome (ARDS) , acute bronchospasm, raised intracranial pressure, acute pulmonary oedema or haemodynamic instability (mean arterial pressure<60 mmHg, arrhythmias).
Outcome results
None listed