Acute Distress Respiratory Syndrome (ARDS), Acute Lung Injury (ALI)
Conditions
Keywords
ALI, ARDS, Noisy pressure support ventilation
Brief summary
Noisy Pressure Support Ventilation (noisy-PSV) would lead to improved lung function, while preserving respiratory muscle unloading. Basically, noisy PSV differs from other assisted mechanical ventilation modes that may also increase the variability of the respiratory pattern (e.g. proportional assist ventilation) by the fact that the variability does not depend on changes in the patient's inspiratory efforts. The aim of this study is to evaluate the optimal variability for noisy PSV in patients with ALI based on its effects on respiratory mechanics, breathing comfort, gas exchange, and hemodynamics. The investigators hypothesize that noise in pressure support leads to variations in VT that are able to improve lung function and that physiologic variables respond differently to the degree of variability in pressure support
Interventions
OTHERNoisy-PSV 1
Noisy-PSV 1: different levels of variable pressure support (PS) will be randomized: a) PS variability equal to 0%, b) PS variability equal to 45%, c) PS variability equal to 90%.
OTHERNoisy-PSV 2
Noisy-PSV 2 : different levels of variable Pressure Support (PS) will be randomized: a) PS equal to Baseline and variability 0%; b) PS equal to Baseline and variability set in order achieve an increase or decrease of pressure of 5 cmH2O; c) PS equal to Baseline - 5 cmH2O and variability 0%; d) PS equal to Baseline - 5 cmH2O and set in order achieve an increase or decrease of pressure of 5 cmH2O.
Sponsors
University of Genova
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Intubated/tracheostomized patients in assisted mechanical ventilation * PaO2/FiO2 100-300, with PEEP ≥ than 5 cmH2O.
Exclusion criteria
* Pregnancy * History of chronic lung disease (COPD) * Presence of thoracic drainage
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effect on arterial oxygenation in each setting of variability | after 45 minutes of mechanical ventilation with each level of variable pressure support | The investigators perform an arterial blood gas and oxygenation is evaluated with PaO2/FiO2 ratio |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| work of breathing | every 9 minutes, up to 45 minutes, of mechanical ventilation in each level of variable pressure support | work of breathing will be recorded as pressure-time product (PTP) measured on the esophageal pressure curve. |
| effects on hemodynamic | after 45 minutes of mechanical ventilation with each level of variable pressure support | the investigator will record blood pressure and cardiac output |
| effect on arterial carbon dioxide | after 45 minutes of mechanical ventilation with each level of variable pressure support | The investigators perform an arterial blood gas and arterial carbon dioxide is evaluated with PaCO2. |
Countries
Italy
Outcome results
None listed