Acute hypoxemic respiratory failure in ICU patients Respiratory
Conditions
Interventions
The study was designed as a randomized crossover physiological investigation.
The sequence of the three interventions (HFNC, Helmet CPAP, HFNC+CPAP) was randomized using a computer-generated randomiza
Helmet CPAP (H-CPAP) with PEEP 8 cmH2O and total flow 80 L/min
Combined HFNC+CPAP with HFNC delivered inside the helmet.
Each intervention lasts 30 minutes. Inspiratory effort, respiratory mechanics, ventilatory pattern, and gas exchange are measured during each
Sponsors
Ospedale Santa Chiara
Eligibility
Sex/Gender
All
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: 1. Adult ICU patients with acute hypoxemic respiratory failure requiring supplemental oxygen therapy to maintain PaO2 >60 mmHg or SpO2 >90%, PaCO2 25 breaths/min 3. Acute onset of symptoms within 7 days of hospital admission 4. Age >18 years
Exclusion criteria
Exclusion criteria: 1. Asthma or COPD exacerbation 2. Cardiogenic pulmonary edema 3. Chronic neuromuscular disease 4. Pulmonary embolism 5. Pregnancy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Inspiratory effort measured using Esophageal pressure swing (?Pes) and simplified esophageal pressure–time product per minute (sPTPes/min) measured using esophageal manometry, at each 30-minute intervention phase (HFNC, H-CPAP, HFNC+CPAP) | — |
Secondary
| Measure | Time frame |
|---|---|
| Gas exchange and respiratory mechanics measured using PaO2/FiO2 ratio, venous admixture, PaCO2, respiratory rate, tidal volume, minute ventilation, dynamic transpulmonary driving pressure (?PL), and dynamic lung compliance, at the final 5 minutes of each 30-minute intervention phase.;Ventilatory load measured using the respiratory rate, minute ventilation (Ve), and Ve corrected for PaCO2 at each 30-minute intervention phase;Oxygenation measured using PaO2/FiO2 ratio and venous admixture obtained from arterial blood gas analysis, at the final 5 minutes of each intervention phase;Pneumatic performance of PEEP valves measured using airway pressure swing (?Paw) and correlation between ?Paw and ?Pes using flow-dependent and flow-independent PEEP valves, at H-CPAP and HFNC+CPAP phases;Non-invasive ventilation (NIV) failure measured using data on the need for endotracheal intubation after non-invasive respiratory support, at within 48 hours after study completion;Patient comfort and dyspnea measured using the Borg dyspnea and discomfort scales, at each intervention phase | — |
Countries
Italy
Contacts
Public ContactSergio Lassola
Outcome results
None listed