ICU, Lung Injury, Mechanical Power, Mechanical Ventilation, Sedation
Conditions
Brief summary
Analgosedation is usually given to critically ill patients admitted in ICU. Fentanyl is the most common agent used for this purpose. For sedative agent, midazolam and propofol are commonly administered. However, too much sedation is apparently associated with increased duration of mechanical ventilation, prolonged ICU stay, and increased mortality. In mechanically ventilated patients, mechanical power is the respiratory mechanic that can predict clinical outcomes including mortality in both ARDS and non-ARDS patients. Previous study demonstrated that sedating mechanically ventilated patients with propofol could decreased mechanical power. This was possibly associated with improved clinical outcomes in these patients. At present, there is no clinical study investigating effects of inhalation sedation on mechanical power and clinical outcomes in mechanically ventilated patients.
Detailed description
In the intensive care unit (ICU), sedation is used to improve comfort and tolerance during mechanical ventilation, invasive diagnostic and therapeutic interventions or nursing care. The most commonly used sedatives are intravenous benzodiazepines and propofol. These agents are associated with over-sedation in 40 to 60% of patients, which can lead to prolonged intubation, delirium and drug-induced hypotension. Volatile anesthetics are increasingly used for sedation in European and Canadian intensive care units that offer advantages of rapid drug on and off effects and clearance via pulmonary exhalation with no active metabolites. Delivery of volatile agents in the ICU can be simply performed using a small lightweight and portable anesthetic reflector so-called anesthesia conserving device. Compared with intravenous sedatives, volatile anesthetics may allow shorter time to extubation and can facilitate mental recovery. In mechanically ventilated patients, a growing body of evidence suggests that the mechanical power (MP) plays an important role in the ventilator-induce lung injury (VILI) and prognosis in in both acute respiratory distress syndrome (ARDS) and non-ARDS patients. MP is the energy per unit time released to the respiratory system according to the tidal volume, PEEP, respiratory rate, and flow applied. In ARDS patients receiving invasive mechanical ventilation, high MP was associated an increased mortality. Moderate to deep sedation can inhibit the respiratory center and reduces the excessive respiratory drive, thereby reducing transpulmonary pressure and MP as well as probably reducing lung injury. The purpose of this study aims to investigate the effect of inhalation sedation on MP in mechanically ventilated patient admitted in the ICU. We hypothesize that MP in mechanically ventilated patients can be reduced by administering inhalational sedation.
Interventions
DRUGInhalational sedation
Inhalational sedation with isoflurane for 12 hours
DRUGConvention sedation
Conventional sedation receiving analgosedation with fentanyl
Sponsors
Mahidol University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patient with age \>18 years old; and 2. Patient who is admitted to the participating ICU; and 3. Patient who receives respiratory support with invasive mechanical ventilation via endotracheal tube \< 12 hours prior to inclusion with anticipated duration of \> 48 hours
Exclusion criteria
1. Patient with history or suspected history of malignant hyperthermia 2. Patient with evident or suspected increased intracranial pressure 3. Patient with high severity of illness whose ICU survival is not expected 4. Patient who refuses or patient whose proxy refuses to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in mechanical power | At 15 hours after intervention applied | Change in mechanical power from Phase 1 to Phase 2 compared between 2 groups |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in oxygenation | At 15 hours after intervention applied | Change in oxygenation from Phase 1 to Phase 2 compared between 2 groups |
| Change in respiratory mechanic | At 15 hours after intervention applied | Change in respiratory mechanic from Phase 1 to Phase 2 compared between 2 groups |
| Change in serum interleukin 6 | At 15 hours after intervention applied | Change in serum interleukin 6 from Phase 1 to Phase 2 compared between 2 groups |
| Change in serum C-reactive protein | At 15 hours after intervention applied | Change in serum C-reactive protein from Phase 1 to Phase 2 compared between 2 groups |
Countries
Thailand
Contacts
PRINCIPAL_INVESTIGATORAnnop Piriyapatsom, MD
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University
Outcome results
None listed