Capnodynamic Monitoring of Cardiorespiratory Function in Patients Admitted to the Intensive Care Unit With COVID-19 Infection, Sepsis and Following Cardiac Surgery
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Acute Respiratory Infection
- Sponsor
- South West Sydney Local Health District
- Enrollment
- 100
- Locations
- 1
- Primary Endpoint
- Prediction by capnodynamic monitoring of combined changes in end expiratory lung volume and effective pulmonary blood flow to assess changes in pulmonary gas exchange during various levels of PEEP
- Last Updated
- 4 years ago
Overview
Brief Summary
Capnodynamic monitoring has the potential to offer continuous and non-invasive measurements of heart and lung function in patients requiring ventilation in an intensive care setting. Since mechanical ventilation with full patient synchronization is commonly used in ICU, capnodynamic monitoring can be immediately embedded in clinical care and compared to current methods of monitoring cardiac output, lung volumes and oxygen delivery. This observational study will explore capnodynamic monitoring in mechanically ventilated patients with a range of cardiorespiratory compromise.
Detailed Description
This study aims to: 1. compare the estimation of cardiac output (CO) using the capnodynamic method (COEPBF) with contemporary reference methods; 2. compare the estimation of mixed venous oxygen saturation (SmvO2) with invasively obtained blood gas analyses; 3. generate observational data on end-expiratory lung volume (EELV) when ventilator settings, and in particular PEEP, are changed; 4. combine 1-3 to provide a physiological construct of cardiorespiratory function
Investigators
Anders Aneman
Conj Professor UNSW, Director ICU Research, Senior Staff Specialist
South West Sydney Local Health District
Eligibility Criteria
Inclusion Criteria
- •Respiratory tract infection:
- •confirmed or highly suspected viral or bacterial pneumonia
- •meeting ARF or ARDS criteria as outlines in the most recent Berlin ARDS consensus statement
- •age 18 years or above
- •arterial and central venous catheters have been inserted or will be inserted as part of routine clinical management
- •mechanical ventilation via an endotracheal tube is expected to continue for the day beyond day of admission
- •adequate transthoracic echocardiographic winds are available to measure the velocity time integral in the left ventricular outflow tract
- •analgosedation is administered as part of routine management of residual neuromuscular blockaded initiated outside ICU OR the administration of analgosedation and/or neuromuscular blockers at doses that achieve full patient-ventilator synchrony are considered part of routine clinical management
- •admitted to ICU with a provisional or established diagnosis of septic shock as defined by the Sepsis-3 criteria
- •age 18 years or above
Exclusion Criteria
- •In all cohorts:
- •age under 18 years
- •known pregnancy
- •arterial and central venous catheters are not indicated as part of routine care
- •known severe valvulopathy
- •ongoing or imminent need for mechanical circulatory support
- •severe haemodynamic instability with imminent transfer for intervention(s) outside ICU
- •patient is not for full active management in ICU
- •patient is not expected to live beyond the day of admission
- •patient is re-admitted to ICU within the same index hospital admission
Outcomes
Primary Outcomes
Prediction by capnodynamic monitoring of combined changes in end expiratory lung volume and effective pulmonary blood flow to assess changes in pulmonary gas exchange during various levels of PEEP
Time Frame: Through study completion, an average of 1 year
At three different levels of PEEP, the interactions between end expiratory lung volume and effective pulmonary blood flow will be assessed and correlated to changes in arterial partial pressure of oxygen and carbon dioxide
Correlation between capnodynamic estimates of mixed venous oxygen saturation and blood gas analysis of blood obtained from the pulmonary artery pulmonary.
Time Frame: Through study completion, an average of 1 year
Capnodynamic estimates of mixed venous oxygen saturation are compared with contemporaneously obtained blood gases from the pulmonary artery catheter
Correlation between capnodynamic effective pulmonary blood flow and cardiac output measured by pulmonary artery thermodilution or echocardiography
Time Frame: Through study completion, an average of 1 year
Capnodynamic measurements of effective pulmonary blood flow are compared with contemporaneously obtained cardiac output measurements using clinical reference methods