Mechanical Ventilation Pressure High, Respiratory Failure
Conditions
Keywords
Esophageal catheter calibration, Assisted mechanical ventilation
Brief summary
Esophageal balloon calibration (EBC) has been proposed during controlled mechanical ventilation in intubated patients in order to optimize esophageal pressure (Pes) signal. Actually, at our knowledge, no data exist about EBC during assisted ventilatory modes such as Pressure Support Ventilation (PSV). The primary endpoint of the present investigation is to assess the feasibility of EBC during PSV and PSV plus Sigh.
Detailed description
Assisted ventilatory modes, nowadays, have been proved to reduce complications related to controlled mechanical ventilation. With these modes, ventilatory cycling is under the patient's control to an extent depending on the type of ventilatory modality. Sigh improves oxygenation and lung mechanics during pressure control ventilation and pressure support ventilation (PSV) in patients with acute respiratory distress syndrome. In order to better quantify the effects of both PSV and PSV plus Sigh on respiratory mechanics, the esophageal pressure monitoring could be helpful. However, esophageal pressure (Pes) assessment requires esophageal ballon calibration (EBC) as demonstrated in intubated patients under controlled mechanical ventilation. At our knowledge, no data exist about EBC during assisted ventilatory modes. The primary aim of the present study is to evaluate the effects of PSV and PSV plus Sigh ventilation on esophageal balloon best volume in patients admitted to the intensive care unit for acute respiratory failure. .
Interventions
OTHEREBC-assisted
After definitive catheter positioning, esophageal balloon calibration will be performed in: 1. volume-controlled mode with tidal volume set to obtain 6-8 lm/kg of ideal body weight (reference), 2. pressure support ventilation (PSV) with support set to obtain a tidal volume ranging between 6-8 ml/kg of ideal body weight at equal PEEP of volume control mode (PSV baseline); 3. PSV + sigh ventilation (sigh setting: total inspiratory pressure equal to 35 cmH2O at a rate of 1/ minute; inspiratory time equal to 4 seconds).
Sponsors
Azienda Ospedaliero Universitaria Maggiore della Carita
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients older than 18 years; * undergoing mechanical ventilation for more than 24 hours (in volume-controlled mode) and with readiness to run assisted ventilation;
Exclusion criteria
* severe COPD with air trapping clinical suspicion; * hemodynamic instability requiring inotropic or vasopressor support; * any contraindications to esophageal catheter positioning
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effects of ventilatory mode on calibrated esophageal ballon best volume | Over 120 minutes in PSV | Evaluation of changes of esophageal balloon best volume (ml) induced by ventilatory modes |
| Number of patients in who esophageal balloon calibration is performed (feasibility) during PSV + Sigh | Over 30 minutes in PSV + Sigh | Evaluate the feasibility of esophageal catheter calibration during assisted ventilation modes during PSV + Sigh |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes of respiratory mechanics indices in PSV | over 30 minutes in PSV | lung, chest wall and respiratory system elastance (cmH2O/l) |
| Changes of respiratory mechanics indices in PSV + sigh | over 30 minutes in PSV + Sigh | lung, chest wall and respiratory system elastance (cmH2O/l) |
| Gas exchange | over 30 minutes during each trial | PaCO2, Ph and blood oxygenation (PaO2) will be obtained performing ABGs. |
Countries
Italy
Outcome results
None listed