Acute Hypercapnic Respiratory Failure
Conditions
Keywords
acute respiratory failure, noninvasive ventilation, sedation, patient/ventilator interaction
Brief summary
In patients undergoing NIV for acute respiratory, lack of tolerance is one of the main reason of failure. This may result in a poor synchrony between the patient and the machine, leading to gross mismatching and potentially to an increased work of breathing. The investigators aim to investigate whether in these patients poorly responding to NIV the use of a sedation protocol using remifentanil will lead to an improve patient-ventilator interaction and better compliance to NIV.
Detailed description
In patients undergoing NIV for acute respiratory, lack of tolerance is one of the main reason of failure. This may result in a poor synchrony between the patient and the machine, leading to gross mismatching and potentially to an increased work of breathing. The investigators aim to investigate whether in these patients poorly responding to NIV the use of a sedation protocol using remifentanil will lead to an improve patient-ventilator interaction and better compliance to NIV. In this physiological study the investigators will study 15 patients at risk of failing NIV because of scarce tolerance and showing clinical signs of poor interaction with the ventilator. Once the patient will be enrolled the investigators will record using the balloon-catheter technique the online measurement of respiratory mechanics, to assess the inspiratory muscle effort and the matching between the patient breathing pattern and that of the ventilator The investigators will also record the clinical success of sedation (i.e. need or not for endotracheal intubation)
Interventions
DRUGRemifentanil
infusion at a rate by 0.025 μg kg-1 min-1 every minute to a maximum of 0.15 μg kg-1 min-1.
Sponsors
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Ph\<7,35 and PaCO2\>50 mmHg with acute respiratory failure * Signs of respiratory distress and poor synchrony with the ventilator as assessed on the ventilator screen and by looking patient own rate and ventilator recorded rate
Exclusion criteria
* Patients responding well to NIV and not showing signs of poor synchrony
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| patient-ventilator interaction | one hour | patient-ventilator interaction will be assessed using the recording of respiratory mechanics to identify |
| matching of inspiratory timing | one hour | the patients inspiratory time vs ventilator inspiratory time |
| Wasted efforts | one hour | breaths unable to trigger the ventilator |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| NIV failure | one hour | failure will be defined as the need for intubation: * gasping for air * worsening of sensorium * respiratory arrest * retention of secretions and/ or death |
Countries
Italy
Contacts
Primary Contactstefano nava, md
Outcome results
None listed