Mechanical Ventilation Complication, Postoperative Pulmonary Atelectasis
Conditions
Keywords
Integrated Pulmonary Index, automated protocol-driven weaning, pulmonary recruitment maneuver
Brief summary
This study evaluates the influence of alveolar recruitment maneuver, protocolized liberation from respiratory support and monitoring of Integrated Pulmonary Index on the duration of the mechanical ventilation and the number of pulmonary complications in the early postoperative period after cardiac surgery.
Detailed description
The outcome of elective off-pump coronary artery bypass grafting (OPCAB) can be significantly compromised due to early postoperative pulmonary complications. The risk of pulmonary complications including acute respiratory distress syndrome (ARDS), atelectases, and early ventilator-associated pneumonia remains inappropriate. Therefore, the maneuvers improving pulmonary aeration and the early restoration of spontaneous breathing activity can be of clinical value. Protocol-driven liberation from mechanical ventilation (CMV) can decrease the duration of CMV as well as the number of pulmonary complications. INTELLiVENT-Assisted spontaneous ventilation (INTELLiVENT-ASV) is a new approach, that may be as effective as conventional protocol-driven liberation from CMV. In parallel, the thorough postoperative monitoring of pulmonary function during both postoperative mechanical ventilation and spontaneous breathing is also of a great value. One of the novel approaches to respiratory monitoring is Integrated Pulmonary Index (IPI). The Integrated Pulmonary Index merges four vital parameters including end-tidal carbon dioxide (EtCO2), respiratory rate, pulse rate, and oxygen saturation (SpO2) measured by capnography and pulse oximetry into a single index value utilizing fuzzy logic model .
Interventions
DEVICEINTELLiVENT-ASV mode
Discontinuation with INTELLiVENT-ASV mode: discontinuation from mechanical ventilation in the early postoperative period will be provided by quick-wean option of INTELLiVENT-ASV mode
DEVICESIMV mode
Discontinuation with SIMV mode: discontinuation with SIMV mode: discontinuation from mechanical ventilation in the early postoperative period will be provided in SIMV mode using physician driven algorithm
Sponsors
Northern State Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Informed consent. * Elective OPCAB.
Exclusion criteria
* Participation in any other study. * Morbid obesity (BWI \> 40). * The risk of pneumothorax after alveolar recruitment due to pulmonary emphysema. * Constant atrial fibrillation with pulse rate exceeding 100/min. * Inability to breathe easily through the nostrils and thus to gain good quality EtCO2 readings while breathing spontaneously, due to chronic rhinitis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of postoperative mechanical ventilation | 24 hrs | Participants will be followed for the duration of mechanical ventilation, an expected average of 4 hrs |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Reduced incidence of postoperative respiratory complications | up to 28 days postoperatively | * Hypoxemia determined as partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) \< 300 mm Hg. * Atelectases. * Nosocomial (ventilator-associated) pneumonia. * Hypoxemia determined as PaO2/FiO2 \< 300 mm Hg. * Atelectases. * Nosocomial (ventilator-associated) pneumonia. Hypoxemia determined as PaO2/FiO2 \< 300 mm Hg, atelectases, • Nosocomial (ventilator-associated) pneumonia. |
| Duration of intensive care unit stay | 72 hours | Participants will be followed for the duration of the ICU stay, an expected average of 48 hrs |
Countries
Russia
Outcome results
None listed