None listed
Conditions
Brief summary
Some patients with subarachnoid haemorrhage (SAH) – a type of bleeding around the brain – need help with breathing. They may be placed on a breathing machine called a ventilator. Ventilators use pressure called PEEP (positive end-expiratory pressure). PEEP helps keep the lungs open so oxygen can move into the blood. Doctors often adjust PEEP levels, but we do not fully understand how these changes affect patients with SAH. This study looks at how different PEEP levels affect oxygen levels, how the lungs move and pressure inside the skull (intracranial pressure). The study will include 20 adults ICU patients at the Austin Hospital who have been diagnosed with SAH, having monitoring for pressure in the brain, have had their aneurysm treated (surgery or a procedure), are on full breathing support from a ventilator and are expected to stay on the ventilator from at least another day. We will record routine breathing information already measured by the ventilator, adjust PEEP levels briefly (commonly 5, 10 or 15 cm H2O), check oxygen levels and how the lungs respond, and collect medical information from the patient’s chart. There is no extra treatment, no added procedures, and no follow-up for patients. The information collected will help improve care for future ICU patients.
Interventions
During the study period, site investigators will visit the bedside daily to identify patients who would be appropriate for the study. The screening periods will be 08:00-10:00. These time periods will be used by site investigators to identify patients with subarachnoid haemorrhage who are mechanically ventilated in a mandatory ventilation mode as part of their clinical management. They will observe clinicians as they assess baseline lung compliance with a brief inspiratory hold manoeuvre and su
During the study period, site investigators will visit the bedside daily to identify patients who would be appropriate for the study. The screening periods will be 08:00-10:00. These time periods will be used by site investigators to identify patients with subarachnoid haemorrhage who are mechanically ventilated in a mandatory ventilation mode as part of their clinical management. They will observe clinicians as they assess baseline lung compliance with a brief inspiratory hold manoeuvre and subsequently adjust the level of PEEP to optimise oxygenation typically applying 5, 10 or 15 cm of H2O of PEEP and record the change in pulse oximeter (SpO2) reading and SpO2/FiO2 ratio after a period of 5-10 minutes to allow for stablisation in parameters. Investigators will also observe the intracranial pressure measurements during the change in ventilator settings. The PEEP setting will then be left at the optimum PEEP as per the treating clinician until the next planned assessment. Clinicians may undertake further PEEP titration between routine assessment as per clinical need.
Sponsors
Austin Hospital
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults aged equal to or greater than 18 years Confirmed diagnosis Subarachnoid haemorrhage (imaging confirmed) Intracranial pressure monitor in situ Intracranial aneurysm secured surgically or endovascularly Being in a mandatory ventilation mode at time of inclusion Expected to be receiving mechanical ventilation support until the day after tomorrow.
Exclusion criteria
Unsecured intracranial aneurysm Known concurrent intracranial aneurysm (non-ruptured) Intracranial hypertension at baseline (ICP greater than 20 mmHg). Severe terminal illness anticipated to die within 48 hours Pregnancy
Outcome results
None listed