Mechanical Ventilation Complication
Conditions
Brief summary
Mechanical ventilation is a vital support associated with the treatment of patients with acute respiratory failure and in other indications such as surgery under general anesthesia, coma or shock. Optimization of settings during mechanical ventilation and implementation of protective ventilation help to avoid ventilation-induced injury, ensure adequate oxygenation and maintain adequate carbon dioxide concentration to avoid respiratory acidosis or alkalosis. Similarly, there is also no clear recommendation, to our knowledge, for the initial setting of the respiratory rate. Therefore, initial settings are not always adequate and in the literature the frequency of respiratory acidosis is very high, reaching about half of the patients receiving mechanical ventilation. VentilO, is an application that is available on smart phones. This educational application provides clinicians with initial settings and optimization of these settings based on gender, height, weight, body temperature and patient type. The algorithm used is based on published data regarding ventilatory requirements in different populations and the anatomical and instrumental dead space of patients. The purpose of our study is to: 1. Assess whether ventilatory settings after intubation are appropriate. 2. To compare the ventilatory adjustments made by clinicians with those proposed by the VentilO appalication.
Interventions
OTHERVentilO application
This educational application provides clinicians with combinations of tidal volume and respiratory rate based on gender, height, weight, body temperature and patient type. The algorithm used is based on published data regarding ventilatory requirements in different populations (i.e. from intubated patients for scheduled surgery to the most severe ICU patients) and anatomical and instrumental dead space. The objective of this application is to help implement personalized protective ventilation in intubated patients according to their characteristics. After patient data entry in the VentilO appllication we will compare the recommended settings (for mechanical ventilation) vs the real clinicial settings done by clinician after patient intubation.We will evaluated the potential effect of the VentilO recommendation on the first arterial (or capillary) blood gases compared to the real settings.
Sponsors
Laval University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults (\> or = 18 years old) * New endotracheal intubation
Exclusion criteria
* Absence of arterial (or capillary) gas within two hours of intubation * Absence of patient sizes available throughout the medical record
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| acid-base abnormalities on arterial (or capillary) blood gases | on the first result available of arterial(or capillary) blood gases after intubation; 2 hours maximum post intubation | evaluate the frequency of acid-base abnormalities, either acidosis or alkalosis, of respiratory or mixed origin on the first arterial gases after intubation. Respiratory acidosis is defined as a pH \< 7.35 with a PaCO2 \> 45 mmHg, and respiratory alkalosis as a pH \> 7.45 with a PaCO2 \< 35 mmHg) |
| Improvement acid-base abnormalities with the VentilO application | on the first result available of arterial(or capillary) blood gases after intubation; 2 hours maximum post intubation | * In case of respiratory acidosis: minute ventilation proposed by VentilO \> set minute ventilation; * In case of respiratory alkalosis: proposed minute ventilation by VentilO \< set minute ventilation |
| Impairement acid-base abnormalities with the VentilO application | on the first result available of arterial(or capillary) blood gases after intubation; 2 hours maximum post intubation | * In case of respiratory acidosis: proposed minute ventilation by VentilO \< set minute ventilation * In case of respiratory alkalosis: minute ventilation proposed by VentilO \> set minute ventilation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ICU length of stay | up to 90 days. ICU stay - ICU admission through ICU discharge or until death if occured | ICU length of stay - ICU admission through ICU discharge |
| Occurence of optimal arterial (or capillary) blood gases result | on the first result available of arterial(or capillary) blood gases after intubation; 2 hours maximum post intubation | An optimal arterial (or capillary) blood gases as defined by a pH between 7.35 and 7.45 with a PaCO2 between 36 and 45 mmHg |
| ICU mortality | up to 90 days. ICU admission through until death if occured | Occurence of death during ICU stay |
| Hospital length of stay | up to 90 days. ICU stay - Emergency department admission through hospital discharge or until death if occured | Hospital length of stay - Emergency department admission through hospital discharge |
| Severity of unbalance of arterial (or capillary) blood gases result | on the first result available of arterial(or capillary) blood gases after intubation; 2 hours maximum post intubation | For acid-base abnormalities, they will be evaluated according to their level of severity: the frequency of moderate (pH between 7.30 and 7.34) and severe (pH \< 7.30) acidoses, and the frequency of moderate (pH between 7.46 and 7.50) and severe (pH \> 7.50) alkaloses. The frequency of moderate (PaCO2 between 46 and 50 mmHg) and severe (PaCO2 \> 50 mmHg) hypercapnia, and the frequency of moderate (PaCO2 between 31 and 35 mmHg) and severe (PaCO2 \< 31 mmHg) hypocapnia |
| hemodynamic instabilities | Between Hour0 to Hour1 after intubation | arterial hypotension requiring vascular filling \> 1000 ml and/or use of vasopressors or inotropes such as levophed or adrenaline at \> 0.05 mcg/kg/min) |
Countries
Canada
Outcome results
None listed