Automatic Adjustmen of Inspiratory Triger and Cycling-off
Conditions
Keywords
patient-ventilator interation, automatic adjustmen of inspiratory triger and cycling-off, Neurally controlled PS
Brief summary
Pressure Support Ventilation use Expiratory triggering sensitivity (Esense) to transfer inspiration to expiration, the value of Esense is fixed. That may lead to asynchrony between humans and ventilators, making people uncomfortable and prolonging weaning time. Furthermore，trigger delay or inffective trigger happens frequently during insppiratory triggering. The ventilators have a compunter drived funcation of automatic adjustmen of inspiratory triger and cycling-off based on waveform, IntelliCycleTM 2.0. It will make the transforming more synchrony with humans. The objectibe of the present study is to detect the effect of automatic adjustmen of inspiratory triger and cycling-off based on waveform on patient-ventilator interation.
Detailed description
This is a physiological cross-over study. Enrolled patient with different baseline respiratory mechanics, for example ARDS patients with low compliance, COPD patient with high airway resistance and postoperative patients with almost normal compliance and airway resistance. Patients are ventilated with PSV+ Automatic adjustmen of inspiratory triger and cycling-off based on waveform, PSV with fixed inspiratory and expiratory and NAVA in two different levels of support. The demographic characteristics, diagnosis, formerly medical history, Ventilator indications, Ventilator data, other respiratory treatments, patient-ventilator interation, work of breathing, Eadi, will be recorded.
Interventions
DEVICEautomatic adjustmen of inspiratory triger and cycling-off based on waveform and PSV with fixed Esence
The ventilators have a compunter drived funcation of automatic adjustmen of inspiratory triger and cycling-off based on waveform, IntelliCycleTM 2.0.
Sponsors
Southeast University, China
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
PSV+ Automatic adjustmen of inspiratory triger and cycling-off based on waveform PSV with fixed inspiratory and expiratory NAVA
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
Postoperation patients 1. receiving invasive mechanical ventilation due to operation 2. abdominal surgery, orthopedic surgery or gynecological surgery 3. without respiratory system Comorbidity 4. able to sustain PSV more than 1 h with inspiratory support ≤ 15 cmH2O. COPD and ARDS patients 1. receiving invasive mechanical ventilation due to acute respiratory failure 2. able to sustain PSV more than 1 h with inspiratory support ≤ 15 cmH2O.
Exclusion criteria
1. age \< 18 or \>85 years, 2. tracheostomy at time of inclusion, 3. contra-indication for nasogastric tube insertion (e.g. history of esophageal varices, gastro-esophageal surgery in the previous 12 months or gastro-esophageal bleeding in the previous 7 days, INR ratio \> 1.5 , APTT \> 44 s, history of leukemia), 4. neuromuscular disease affecting spontaneous breathing (e.g. history of acute central or peripheral nervous system disorder or neuromuscular disease with irregular spontaneous rhythm), 5. hemodynamic unstable (heart rate \> 140 beats/min, vasopressors required with ≥ 5 μg.kg-1.min-1 dopamine/ dobutamine, or ≥ 0.2 μg.kg-1.min-1 norepinephrine), 6. sedation level Richmond Agitation-Sedation Scale (RASS) ≤ -2 or ≥ 2, 7. lack of informed consent and patients included in other intervention study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Asynchrony Index | 20 minutes | number of asynchrony events divided by the total neural respiratory rate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Respiratory Patterns | 20 minutes | Patient Respiratory Patterns during Pressure Support Ventilation |
| gas exchange | 20 minutes | Patient gas exchange during Pressure Support Ventilation |
| work of breathing | 20 minutes | work of triggering and respiratory in different arms |
| other patient-ventilator synchrony parameters | 20minutes | trigger and cycle-off asynchrony, Ineffective efforts, double triggering, auto-triggering, premature cycling and late cycling |
Countries
China
Outcome results
None listed