ARDS, Human
Conditions
Brief summary
Expiratory flow limitation (EFL) is defined as a dynamic condition that expiratory flow cannot be further increased with higher expiratory driving pressure. Under mechanical ventilation, it can cause intrinsic positive end-expiratory pressure (PEEP) and dynamic hyperinflation, and be associated with worse clinical outcome. The detection of EFL however needs special maneuvers and offline analysis of flow-volume curves, which are infeasible in routine practice and cannot be used during real-time monitoring. The investigators propose a new and simple approach using flow derived parameters to detect EFL in real time without needing any intervention.
Interventions
None listed
Sponsors
Unity Health Toronto
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
1. Age ≥18 years, intubated or tracheostomized 2. Receiving invasive mechanical ventilation in assist/control mode with PEEP ≥ 5 cmH2O 3. Receiving continuous intravenous sedation 4. Displaying a monotonous regular breathing pattern with no obvious asynchrony
Exclusion criteria
1. Severe hypoxemia in baseline clinical ventilator settings (SpO2 \< 90%) 2. Hemodynamic instability (mABP \<60 mmHg, systolic arterial pressure \>180 mmHg, heart rate \<40/min or \>150/min)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Outcome (Presence / absence of EFL) will be determined by off-line analysis of recorded flow-volume loops during PEEP reduction. | 2 years |
Secondary
| Measure | Time frame |
|---|---|
| Percentage of intrinsic PEEP caused by the EFL. | 2 years |
Countries
Canada
Outcome results
None listed