Critical Illness, Intensive Care, Mechanical Ventilation, Ventilation Weaning
Conditions
Keywords
Sleep pattern, Mechanical ventilation, weaning, Intensive Care, NAVA (Neurally Adjusted Ventilatory Assist), PAV+ (Proportional Assist Ventilation Plus)
Brief summary
Neurally adjusted ventilatory assist (NAVA) and Proportional Assist Ventilatory Plus (PAV +) are new modes of mechanical ventilation that delivers ventilatory assist in proportion to the electrical activity of the diaphragm for NAVA and to patients efforts for PAV +. The goal of this trial is to compare oxygenation,ventilator comfort, patients -ventilator asynchronies, and sleep pattern between NAVA and PAV+.
Detailed description
Twenty patients will be enrolled. They will be ventilated with PAV+ and NAVA for one day, each in a randomized crossover order. The oxygenation,ventilator comfort, patients -ventilator asynchronies, and sleep pattern will be compared.
Interventions
OTHERNAVA ventilatory mode
The two ventilatory modes will be studied during 24h in intubated patients in random order.
OTHERPAV+ ventilatory mode
The two ventilatory modes will be studied during 24h in intubated patients in random order.
Sponsors
University Hospital, Montpellier
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Estimated remaining duration of mechanical ventilation for more than two days * patient alert and calm * Surrogate decision maker's consent
Exclusion criteria
* Clinical contraindication for the use of NAVA: contraindications for an EAdi catheter placement (e.g., esophageal varices, upper gastrointestinal bleeding, gastroesophageal surgery) * Clinical instability for any reason * Contraindications for continuing intensive care treatment * Patient under tutelage * Age \< 18 years * Pregnancy * No French health insurance
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Oxygenation in NAVA and in PAV+ | after one day of ventilation in NAVA and in PAV+ |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ventilatory comfort | Every 6 hours in the two ventilatory modes | Ventilatory comfort will be assessed by : * objective criteria expressed in time spent in each mode in the area called comfort (12 \< Respiratory frequence \< 28 c/min ; Current Volume \> 300 mL and EtCO2 \< 55 mmHg) * subjective criteria expressed by the self-assessment of the patient's comfort on a visual analogic scale. |
| Patient-ventilator asynchronies | During the 24h of mechanical ventilation in NAVA and in PAV+ | The patient-ventilator asynchronies will be assessed by the asynchronie index (number of asynchronies / number of respiratory cycles). The number of asynchronies will be assessed by the investigator, on the records of the pression curves and the respirator outputs. |
| Ventilatory parameters | During the 24h of mechanical ventilation in NAVA and in PAV+ | The aeration and pulmonary ventilation will be assessed by electrical impedance (PulmoVista®500, Drager, Suisse). |
| Sleep pattern | During 24h of mechanical ventilation in NAVA and in PAV+ | — |
Countries
France
Outcome results
None listed