CO2 Clearance, Mask Comfort, Rebreathing Exhaled Gas
Conditions
Brief summary
This study will be a randomized crossover trial that will be conducted at Rush University. The study will be conducted with 20 healthy volunteers who will be placed on ICU ventilator operating in the NIPPV mode. All subjects will perform 15 minutes of breathing on NIPPV on each mask of the 4 different masks (2 oronasal and 2 full face masks) that are randomly selected. Breathing through each mask will be followed by a 5- minute wash out period between masks. End tidal Carbon Dioxide (EtCO2) will be sampled nasal/oral. Different levels of EPAP will be set and CO2 clearance will be monitored. Additionally, subjective mask comfort will be assessed via visual analog scale (VAS) with 1 referring to least comfortable and 5 being the most comfortable.
Detailed description
This study will be a randomized crossover trial that will be conducted at Rush University. Normal volunteers will be recruited from Rush University Medical Centers. Volunteers will be screened with inclusion and exclusion criteria and an informed consent is required in order for them to participate. Also, initial baseline vital signs (heart rate, blood pressure, respiratory rate, and oxygen saturation) will be obtained. EtCO2 will be obtained at baseline and periodically using an oral/nasal sample line with the CapnostreamTM 20p monitor (Medtronic, Minneapolis, MN). The study will use a double limb circuit ICU ventilator Puritan Bennett™ (Medtronic, Dublin, Ireland). Investigators will evaluate 4 NIPPV masks (2 oronasal masks and 2 full face masks). Oronasal masks will be labeled as group A and numbered as A1 and A2; while full face masks will be labeled group B and numbered as B1 and B2. Order of the masks will be randomly chosen in two steps. First steps will be choosing A or B then randomly assign mask in each of these groups. Investigators will randomly assign mask in group A or B by drawing an initial mask from the group and then continue the sequence of masks from that point. For example, investigators randomly chose group A, then randomly chose A2, the sequence will be A2, A1. Then Investigators would randomly choose B2, then the sequence would be B2, B1. All subjects will perform 15 minutes on each mask followed by 5 minutes wash out interval between masks. EPAP levels will be 0, 2, 4, & 5 while IPAP remains at 5 higher than EPAP. EtCO2 will be collected at 4:00, 4:30 and 5:00 minute mark. These three measures should differ by less than 20% of their average. Also, subjective mask ORA: 18011502-IRB01 Date IRB Approved: 3/30/2018 Amendment Date: 5/11/2018 comfort will be assessed via visual analog scale (VAS) with 1 referring to least comfortable and 5 being the most comfortable after 5 each EPAP setting.
Interventions
Order of the masks (BiTrac MaxShield™ with standard elbow, BiTrac™ Full Face with standard elbow, Respironics PerforMax with standard elbow, and Respironics AF531 with standard elbow) were randomly chosen. Investigators randomly assigned all masks for paper raffling from container. All subjects performed 20 minutes on each mask followed by 5 minutes wash out interval between masks. EPAP levels will be 0, 2, 4, & 5 (5 minutes for each level) while IPAP remains at 5 higher than EPAP. FiCO2 and EtCO2 were collected at 4:00, 4:30 and 5:00 minute mark for each EPAP level. Also, subjective mask comfort was assessed via visual analog scale (VAS) with 1 referring to least comfortable and 5 being the most comfortable after 5 each EPAP setting.
Sponsors
Study design
Intervention model description
randomized crossover trial
Eligibility
Inclusion criteria
* Healthy subjects greater than 18 years old.
Exclusion criteria
* Prior history of NIPPV as a patient. * Facial surgery or deformity * Ear infection * History of pulmonary or cardiac disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Carbon Dioxide Clearance From the Masks | 5 min | Measured the percentage of CO2 being re-breathed or inspired using a nasal cannula and sidestream end-tidal CO2 monitor. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Leak (L/Min) | 5 min | Amount of leak measured by the ventilator. |
| Tidal Volume | 5 minutes | Tidal volume measured by the ventilator. |
| Respiratory Rate (BPM) | 5 minutes | The ventilator measured the subjects' respiratory rates. |
Countries
United States
Participant flow
Pre-assignment details
This was a randomized crossover trial so each participate used all four masks (BiTrac MaxShield™ with standard elbow, BiTrac™ Full Face with standard elbow, Respironics PerforMax with standard elbow, and Respironics AF531 with standard elbow).
Participants by arm
| Arm | Count |
|---|---|
| Randomized Crossover Trial With 4 NIV Masks Order of the masks (BiTrac MaxShield™ with standard elbow, BiTrac™ Full Face with standard elbow, Respironics PerforMax with standard elbow, and Respironics PerforMax with standard elbow) were randomly chosen. Investigators randomly assigned all masks for paper raffling from container. All subjects performed 20 minutes on each mask followed by 5 minutes wash out interval between masks. EPAP levels will be 0, 2, 4, & 5 (5 minutes for each level) while IPAP remains at 5 higher than EPAP. FiCO2 and EtCO2 were collected at 4:00, 4:30 and 5:00 minute mark for each EPAP level. Also, subjective mask comfort was assessed via visual analog scale (VAS) with 1 referring to least comfortable and 5 being the most comfortable after 5 each EPAP setting.
Evaluated masks used for NIV with mechanical ventilators: Order of the masks were randomly chosen. Investigators randomly assigned all masks for paper raffling from container. All subjects performed 20 minutes on each mask followed by 5 minutes wash out interval between masks. EPAP levels will be 0, 2, 4, & 5 (5 minutes for each level) while IPAP remains at 5 higher than EPAP. FiCO2 and EtCO2 were collected at 4:00, 4:30 and 5:00 minute mark for each EPAP level. Also, subjective mask comfort was assessed via visual analog scale (VAS) with 1 referring to least comfortable and 5 being the most comfortable after 5 each EPAP setting. | 8 |
| Total | 8 |
Baseline characteristics
| Characteristic | Randomized Crossover Trial With 4 NIV Masks | — |
|---|---|---|
| Age, Customized greater than 18 | 8 Participants | — |
| No current ear infection | 8 Participants | — |
| no facial surgery or deformity that would interfere with the mask seal. | 8 Participants | — |
| No history of pulmonary or cardiac disease | 8 Participants | — |
| No history of use of noninvasive ventilation | 8 Participants | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Sex/Gender, Customized Not collected | 0 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 8 |
| other Total, other adverse events | 0 / 8 |
| serious Total, serious adverse events | 0 / 8 |
Outcome results
Carbon Dioxide Clearance From the Masks
Measured the percentage of CO2 being re-breathed or inspired using a nasal cannula and sidestream end-tidal CO2 monitor.
Time frame: 5 min
Population: The study protocol and statistical analysis planned to have this outcome measure be analyzed and reported per PEEP level, not per intervention. There were 8 participants and 4 masks, making 32 unique measures for each PEEP level. This pilot project aimed to identify that CO2 rebreathing existed when using a dual limb circuit. Individual mask data may misrepresent the issue and be inappropriately used for marketing purposes.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| PEEP 0 | Carbon Dioxide Clearance From the Masks | 1.83 percentage of CO2 inspired |
| PEEP 2 | Carbon Dioxide Clearance From the Masks | 1 percentage of CO2 inspired |
| PEEP 4 | Carbon Dioxide Clearance From the Masks | 0.49 percentage of CO2 inspired |
| PEEP 5 | Carbon Dioxide Clearance From the Masks | 0 percentage of CO2 inspired |
Leak (L/Min)
Amount of leak measured by the ventilator.
Time frame: 5 min
Population: The study protocol and statistical analysis planned to have this outcome measure be analyzed and reported per PEEP level, not per intervention. There were 8 participants and 4 masks, making 32 unique measures for each PEEP level. This pilot project aimed to identify that CO2 rebreathing existed when using a dual limb circuit. Individual mask data may misrepresent the issue and be inappropriately used for marketing purposes.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| PEEP 0 | Leak (L/Min) | 22 Liters per minute |
| PEEP 2 | Leak (L/Min) | 30 Liters per minute |
| PEEP 4 | Leak (L/Min) | 36 Liters per minute |
| PEEP 5 | Leak (L/Min) | 41 Liters per minute |
Respiratory Rate (BPM)
The ventilator measured the subjects' respiratory rates.
Time frame: 5 minutes
Population: The study protocol and statistical analysis planned to have this outcome measure be analyzed and reported per PEEP level, not per intervention. There were 8 participants and 4 masks, making 32 unique measures for each PEEP level. This pilot project aimed to identify that CO2 rebreathing existed when using a dual limb circuit. Individual mask data may misrepresent the issue and be inappropriately used for marketing purposes.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| PEEP 0 | Respiratory Rate (BPM) | 13 breaths per minute |
| PEEP 2 | Respiratory Rate (BPM) | 15 breaths per minute |
| PEEP 4 | Respiratory Rate (BPM) | 15 breaths per minute |
| PEEP 5 | Respiratory Rate (BPM) | 15 breaths per minute |
Tidal Volume
Tidal volume measured by the ventilator.
Time frame: 5 minutes
Population: The study protocol and statistical analysis planned to have this outcome measure be analyzed and reported per PEEP level, not per intervention. There were 8 participants and 4 masks, making 32 unique measures for each PEEP level. This pilot project aimed to identify that CO2 rebreathing existed when using a dual limb circuit. Individual mask data may misrepresent the issue and be inappropriately used for marketing purposes.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| PEEP 0 | Tidal Volume | 636 milliliters |
| PEEP 2 | Tidal Volume | 646 milliliters |
| PEEP 4 | Tidal Volume | 637 milliliters |
| PEEP 5 | Tidal Volume | 701 milliliters |