Distress Respiratory Syndrome, Weaning Failure
Conditions
Keywords
patient-ventilator interaction, pediatric acute respiratory distress syndrome, difficult weaning
Brief summary
This study assessed the effects of NAVA versus Pressure Support Ventilation (PSV) on patient-ventilator interaction in pediatric patients with difficult weaning from mechanical ventilation after moderate Pediatric Acute Respiratory Distress Syndrome (PARDS).
Detailed description
12 pediatric patients, admitted in Pediatric Intensive Care Unit (PICU) with moderate PARDS and who failed up to 3 SBTs in less than 7 days, were enrolled in this study. These patients underwent three studies conditions, lasting 1 hour each: Pressure support ventilation 1, Neurally adjusted ventilatory assist and Pressure support ventilation 2. During each trial were recorded the patient tracings of flow, airway pressure and electrical activity of diaphragm for the patient-ventilator interaction analysis.
Interventions
DEVICEpressure support ventilation versus neurally adjusted ventilatory assist
All patients underwent three mechanical ventilation modes, lasting 1 hour each: pressure support mode, neurally adjusted ventilatory assist and again pressure support ventilation
Sponsors
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Observational model
CASE_CROSSOVER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
1 Months to 2 Years
Healthy volunteers
No
Inclusion criteria
* diagnosis of moderate PARDS * 3 spontaneous breathing trials failed in less than 7 days
Exclusion criteria
* hemodynamic instability * severe respiratory instability * contraindication to nasogastric tube exchange * increase in intracranial pressure * palliative care for end-stage oncologic disease * neuromuscular disease * lesions of medulla
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| asynchrony index | three years | in each study condition, the asynchrony index was measured. The asynchrnony index value grater than 10% is an indicator of worsening patient-ventilator interaction. the Asynchrony Index is the ratio between the number of asynchronous events and the total respiratory rate, expressed as percentage |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| patient-ventilator interaction | three years | the variable describing patient-ventilator interaction is the inspiratory trigger delay (defined as the time lag between the onset of neural inspiration and the onset of ventilatory assistance and measured in milliseconds ) |
| interaction | three years | another variable describing patient-ventilator interaction is the expiratory trigger delay ( defined as the time lag between the neural expiration and the end of mechanical assistance and measured in milliseconds) |
| synchrony between patient and mechanical ventilator | three years | the time of synchrony is the time during which the patient inspiratory effort and the ventilatory assistance are in phase and measured in milliseconds). |
Outcome results
None listed