Obstructive Airway Diseases
Conditions
Keywords
External PEEP, intrinsic PEEP, controlled mechanical ventilation
Brief summary
This experimental physiologic study is conducted to determine the effect of different mechanical ventilation settings (in terms of positive end-expiratory pressure) on patients receiving mechanical ventilation with expiratory flow obstruction and autoPEEP. The main question it aims to answer In patients with autoPEEP, what is the effect of applying external PEEP on gas exchange and the lung emptying pattern in patients with total ventilatory support? Participants must comply: \- Age \> 17 years. * Invasive mechanical ventilation (endotracheal tube or tracheostomy) in controlled mode, with SpO2 \> 90%, for more than 12 hours. * No contraindications for abdominal compression. * Presence of autoPEEP greater than 3 cmH2O measured in mechanical ventilation with total support and ZEEP. * Total mechanical respiratory support, without respiratory muscle activity (inspiratory or expiratory).
Detailed description
The study includes patients with controlled mechanical ventilation and autoPEEP. By programming different levels of external PEEP, its effect on respiratory mechanics, gas exchange, and pulmonary emptying constants will be determined. Once included in the study, participants remain on the established mechanical ventilation schedule.Subsequently, they will remain for 5 minutes at each programmed PEEP level, during which the variables under study will be recorded. They will remain at 3 PEEP levels for 15 minutes before taking arterial blood gas samples. The variables under study will be recorded and stored in a respiratory monitor and an electrical impedance tomograph, and subsequently analyzed offline.
Interventions
OTHERPEEP titration
External PEEP will be increased by 3 cmH₂O, from 0 to 15 cmH₂O.
Sponsors
Hospital Donación Francisco Santojanni
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Age \> 17 years. Invasive mechanical ventilation (endotracheal tube or tracheostomy) in controlled mode, with SpO2 \> 90%, for more than 12 hours. No contraindications for abdominal compression. AutoPEEP greater than 3 cmH2O measured during mechanical ventilation with full support and ZEEP. Full mechanical respiratory support, with no respiratory muscle activity (inspiratory or expiratory). \-
Exclusion criteria
Cardiovascular instability: Hypotension (MAP \< 60 mmHg), hypertension (SBP \> 180 mmHg), heart rate \< 40 bpm or \> 150 bpm. Refusal to participate in the study by a family member (without signed informed consent). Evidence of air leak: Pneumothorax, subcutaneous emphysema, pneumomediastinum. Intracranial hypertension (ICP \> 20 mmHg). Pregnant patient. Body Mass Index greater than 40 kg/m².
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To evaluate the expiratory time constant as a function of external PEEP. | 1 hour | Methodology: the expiratory pattern is defined through the expiratory time constant at different PEEP levels relative to the reference (ZEEP). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To evaluate thel effect of external PEEP in gas exchange respect to reference (ZEEP) | 1 hour | Gas exchange: Methodology: Arterial blood gas samples (PaO2 and PaCO2 in mmHg) are taken after a 15-minute stability period at three time points: without external PEEP (reference), and 3 cmH2O below and 3 cmH2O above final PEEP. |
Countries
Argentina
Outcome results
None listed