Respiratory effort-guided sedation in patients with acute respiratory distress syndrome Acute respiratory distress syndrome, sedation, neuromuscular blocking agent, respiratory effort, respiratory drive
Conditions
Interventions
At baseline, P0.1, predicted transpulmonary driving pressure (predicted delta PL), Pocc, vital signs, Richmond Agitation-Sedation Scale (RASS), and electrical impedance tomography (EIT) data are recor
Experimental Procedure/Surgery,Active Comparator Procedure/Surgery
Respiratory effort-guided sedation,Sedation adjustment as usual care
Sponsors
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Mechanically ventilated patients meeting the Berlin definition of acute respiratory distress syndrome within 24 hours of intensive care unit admission 2. PaO2/FiO2 ratio of 150 mmHg or less within the first 24 hours after initiation of mechanical ventilation
Exclusion criteria
Exclusion criteria: 1. PaO2/FiO2 ratio of 150 mmHg or less after 48 hours of mechanical ventilation 2. Presence of bronchopleural fistula 3. Severe chronic lung disease, causing disability and requiring long-term home oxygen therapy 4. Pre-existing pulmonary hypertension 5. Presence of large intrathoracic mass 6. Contraindications to monitoring with electrical impedance tomography, such as chest wounds or burns, chest trauma, chest tube placement, or implanted electronic devices 7. Hemodynamic instability, defined as systolic blood pressure less than 80 mmHg or mean arterial pressure less than 60 mmHg despite vasopressor support, and/or heart rate less than 55 bpm 8. Patients at risk of increased intracranial pressure or during post-cardiac arrest care 9. Neurologic disorders associated with impaired consciousness 10. Status epilepticus 11. Neuromuscular diseases 12. Pregnancy 13. Inability to perform electrical impedance tomography monitoring (for example, electrical impedance tomography device unavailable) 14. Patients not receiving full intensive care treatment or with an expected survival less than 24 hours 15. Presence of the other acute medical conditions, specifically thyroid storm, psychosis, and alcohol withdrawal 16. Bedridden patients 17. Advanced-stage malignancy 18. Patients receiving palliative care 19. Patients with a do-not-resuscitate (DNR) order 20. Refusal of participation by the attending intensivist or primary physician 21. Refusal of participation by the patient or the patient's legal representative
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Successful weaning of sedation Day 3 Percentage of reduction in sedation dose; Richmond Agitation-Sedation Scale | — |
Secondary
| Measure | Time frame |
|---|---|
| Level of sedation Day 3 Richmond Agitation-Sedation Scale,Sedation dose Day 3 Milligram, microgram (per kilogram of body weight),Respiratory effort parameters Day 3 cmH2O,Desaturation Day 3 Number of events,Ventilator-free days Day 28 Number of days,Mortality Day 28 Number of deaths | — |
Countries
Thailand
Contacts
Public ContactPongdhep Theerawit
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Outcome results
None listed