Mechanical Ventilation Complication, Perfusion; Complications
Conditions
Keywords
Renal blood perfusion, Mechanical ventilation
Brief summary
The present study aims to evaluate, with non-invasive methods, the relationships existing between PEEP and renal perfusion in patients undergoing surgery and requiring ventilatory support and monitoring in intensive care. Renal perfusion will be assessed at baseline (PEEP 0), subsequently ,at the application of progressive increases of PEEP. At the end of the measurements, the implications of the use of PEEP on the renal vascular system will be analyzed.
Detailed description
The present physiological, monocentric, observational clinical study evaluates the effect of progressive PEEP increases on renal perfusion in mechanically ventilated patients who underwent surgery with the need of ventilatory support and monitoring in intensive care. Precisely, will be evaluated: * The morphometric parameters (coronal diameter and cortico-medullary thickness) and the renal resistive indices (IR). The inter-lobar arteries will be sampled and the IRs will be measured as the upper and lower level and the mesorenes. Measurements will be performed both in the kidney and in baseline conditions and incremental values of PEEP (0 - 6 - 12). * Gas exchanges, FC, systolic BP, diastolic and mean, Pmax, P1 and P2 of the airways, total and ohmic resistances and static respiratory compliance indexed for weight body (RRSmaxI, RRSminI, CrsI will be recorded). The intra-class correlation coefficient will be measured to estimate the intra-observer reproducibility of the conducted measurement.
Interventions
None listed
Sponsors
St. Bortolo Hospital
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 Years and older * Receiving mechanical ventilation, invasive blood pressure monitoring and an urinary catheter to monitor diuresis * Need for postoperative monitoring in intensive care * Written informed consent;
Exclusion criteria
* Acute kidney injury defined according to KDIGO guidelines; * Pre-existing chronic renal disease; * Heart failure; * ARDS; * Sepsis and Septic Shock; * Hemodynamic instability with the need for vasoactive support; * Chronic or occasional therapy with drugs that could modify the renal blood flow and that can not be suspended two days before the study (Vasoactive agents, Ace-inhibitors, Beta-blockers, NSAIDs, Sartans and Diuretics therapy); * Presumed or established state of pregnancy; * Refusal of informed consent;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Association between IR and PEEP | Change from baseline to 60 minutes | Resistive index will be measured in both kidney and recorded using multifrequency convex probe.The association between positive end expiratory pressure and resistive index will be analyzed as the primary outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Association between PEEP and Hemodynamics Paramenters | Change from baseline to 60 minutes | Resistive index will be measured in both kidney and recorded using multifrequency convex. FC, systolic, diastolic and mean PA will be measured at each PEEP level |
Other
| Measure | Time frame | Description |
|---|---|---|
| Association between IR and Respiratory exchanges | Change from baseline to 60 minutes | Resistive index will be measured in both kidney and recorded using multifrequency convex. PaO2 and PaCO2 will be analyzed at each PEEP level. |
Countries
Italy
Contacts
Primary ContactSilvia De Rosa, MD
Outcome results
None listed