Critical Care
Conditions
Keywords
pulmonary reexpansion, air stacking, mechanical ventilation
Brief summary
A cross-over randomized clinical trial carried out at the Intensive Care Unit. Patients who are on mechanical ventilation for more than 24 hours will be included in the study. The following techniques will be applied: aspiration in a closed system with an expiratory pause of 10 seconds associated to hyperinflation maneuver with a mechanical ventilator with the Air Stacking technique and aspiration technique in a closed system of aspiration with an expiratory pause of 10 seconds.
Detailed description
After randomization, all patients will be positioned in dorsal decubitus with the head elevated at 30 degrees and will be aspirated once with a closed suction system and with a vacuum limited to 150 cmH2O. Two hours later, hemodynamic and ventilatory parameters will be collected and recorded. If randomized to Protocol 1 (Air Stacking technique), the aspiration technique with closed system and expiratory pause will be performed three times during a 30-second interval, with a probe of the same caliber and the same vacuum value. One ml of saline solution will be instilled in the aspiration system to washing the closed suction circuit. Immediately after, the Air Stacking maneuvers will be performed. If Protocol 2 (No Air Stacking technique), only tracheal suction with closed system. Hemodynamic and ventilatory parameters will be collected after 1, 10 and 30 minutes of application. The secretions aspirated into the collection flasks will then be weighed, on a precision balance, by a collaborator blinded that is not part of the study, and the weight will be transcribed to the data collect.
Interventions
Air Stacking lung reexpansion technique after aspiration with expiratory pause in a closed system.
OTHERNo Air Stacking Technique
Aspiration technique in a closed system of aspiration with an expiratory pause of 10 seconds.
Sponsors
Hospital Nossa Senhora da Conceicao
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients 18 years or older * patients on mechanical ventilation for more than 48 hours * patients on volume or pressure controlled ventilatory mode * patients hemodynamically stable (equal mean blood pressure or more than 60 mmHg, and dose of Norepinephrine less than 1μg / Kg / minute) * patients whose legal representatives authorize participation in the study.
Exclusion criteria
* undrained pneumothorax and hemothorax, and emphysema subcutaneous * fracture of ribs * ventilatory parameters with peak pressure greater than 40 cm/H2O
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tidal Volume (VT) (ml) | At 30-minute after the application of the studied technique. | The tidal volume will be visualized directly at mechanical ventilation monitor. Variations in tidal volume will be considered before and after the interventions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Peripheral arterial oxygen saturation (SpO2) (%) | 1, 10 and 30-minute after the application of the studied technique. | The SpO2 will be visualized on the monitor of the patient, and the value will be noted. |
| Peak inspiratory pressure (PIP) (cm H2O) | 1, 10 and 30-minute after the application of the studied technique. | The PIP will be visualized directly at mechanical ventilation monitor, and the value will be noted. |
| End expiratory pressure (PEEP) (cmH2O) | 1, 10 and 30-minute after the application of the studied technique. | The PEEP will be visualized directly at mechanical ventilation monitor, and the value will be noted. |
| Air trapping (AUTO-PEEP) (cmH2O) | 1, 10 and 30-minute after the application of the studied technique. | The AUTO-PEEP will be visualized directly at mechanical ventilation monitor, and the value will be noted. |
| Mechanical ventilation circuit pressure (cmH2O) | 1, 10 and 30-minute after the application of the studied technique. | The mechanical ventilation circuit pressure will be visualized directly at mechanical ventilation monitor, and the value will be noted. |
| Endotracheal tube diameter (ETT) (mm) | 1-minute after the application of the studied technique. | The endotracheal tube diameter is directly written in the product package. |
| Weight of secretion aspirated (grams) | Immediately after the application of one of the protocols. | The secretion aspirated into the collection flask will be weighed on a precision laboratory scale. |
| Resistance (R) (L/s) | 1, 10 and 30-minute after the application of the studied technique. | The R will be visualized directly at mechanical ventilation monitor, and the value will be noted. |
| Drive pressure (cmH2O) | 1, 10 and 30-minute after the application of the studied technique. | The drive pressure will be calculated by the difference between plateau pressure and positive end-expiratory pressure in the mechanical ventilation, and the value will be noted. |
| Heart rate (HR) (beats per minute) | 1, 10 and 30-minute after the application of the studied technique. | The HR will be visualized on the monitor of the patient, and the value will be noted. |
| Respiratory rate (RR) (breaths per minute) | 1, 10 and 30-minute after the application of the studied technique. | The RR will be visualized on the monitor of the patient, and the value will be noted. |
| Mean arterial pressure (MAP) (mmHg) | 1, 10 and 30-minute after the application of the studied technique. | The MAP will be calculated using the systolic and diastolic blood pressure, and the value will be noted. |
| Dynamic compliance (Cd) (ml/cmH2O) | 1, 10 and 30-minute after the application of the studied technique. | The Cd will be visualized directly at mechanical ventilation monitor, and the value will be noted. |
Countries
Brazil
Contacts
Primary ContactFernanda M Kutchak, Master
Backup ContactSilvia RR Vieira, PhD
Outcome results
None listed