Adaptive Support Ventilation in Acute Respiratory Distress Syndrome (ARDS)

Not Applicable

• Conditions: Respiration, Artificial; Respiratory Distress Syndrome, Adult
• Interventions: Procedure: type of mechanical ventilation

• Registration Number: NCT01165528
• Lead Sponsor: Post Graduate Institute of Medical Education and Research, Chandigarh

Brief Summary

Prospective randomized controlled trial to be conducted in the Respiratory Intensive Care Unit (RICU) of Post Graduate Institute of Medical Education And Research (PGIMER),Chandigarh. The study is approved by the Institute Ethics committee. In view of lack of previous outcome data in such patients, all patients requiring RICU admission for acute respiratory distress syndrome(ARDS) between January 2010 and June 2011 are being enrolled in this pilot study.

The patients meeting the aforementioned criteria will randomly assigned to ventilation with assist control mode ventilation (ACMV group) as per the ARDSnet strategy or adaptive support ventilation (ASV group). Being the first RCT of its type, patients will be first stabilized on ACMV for 1 hour to determine the adequate minute ventilation. The randomization sequence will be computer generated. The assignments will placed in sealed opaque envelopes and each patient's assignment was made on admission to the RICU by the attending physician. Blinding of treatment is not possible.

All patients will be ventilated only by Galileo Gold ventilators (Hamilton medical systems, Bonaduz, Switzerland). Patients randomized to the ACMV group will be ventilated according to low tidal volume strategy of 6ml/kg with Fio2/PEEP as per ARDSnet table to achieve a saturation between 88-95% with the lowest possible Fio2 to maintain plateau pressures \< 30 cms H2o and PH \> 7.3 with option to reduce tidal volume to 4 ml/kg and increase respiratory rate to 35/ min to achieve the above said goals11.These patients will be weaned as per standard protocol of spontaneous breathing trial of 30 minutes once they are recognized eligible as per statement of the sixth International consensus conference on weaning.

Detailed Description

Inclusion criteria:

Study to include at least 40 patients admitted to RICU with diagnosis of ARDS as defined by American European consensus committee in 1994.

1. Acute onset shortness of breath(\<7 days)

2. PaO2/FiO2 \< 200 mm Hg (regardless of PEEP)

3. Bilateral infiltrates on frontal chest radiograph

4. \<18 mm Hg when measured or no clinical evidence of left atrial hypertension

Exclusion criteria:

1. Age less than 12 years

2. Patients having underlying chronic lung disease (COPD, interstitial lung disease, pulmonary hypertension)

3. Contraindication to permissive hypercapnea (raised intracranial pressure, acute cerebrovascular disorders, acute or chronic myocardial ischemia, right ventricular failure, uncorrected severe metabolic acidosis, sickle cell anemia, tricyclic antidepressant overdose, pregnancy)

Study Timeline

• Status Verified: 2009-12
• Study Start: 2010-01
• Study First Submitted: 2010-07-16
• Study First Submitted QC: 2010-07-19
• Last Update Submitted: 2010-07-19
• Study First Posted: 2010-07-20
• Last Update Posted: 2010-07-20
• Primary Completion: 2011-06

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• Acute onset shortness of breath(<7 days)
• PaO2/FiO2 < 200 mm Hg (regardless of PEEP)
• Bilateral infiltrates on frontal chest radiograph
• <18 mm Hg when measured or no clinical evidence of left atrial hypertension

Exclusion Criteria

• Age less than 12 years
• Patients having underlying chronic lung disease
• Contraindication to permissive hypercapnia (raised intracranial pressure, acute cerebrovascular disorders, acute or chronic myocardial ischemia, right ventricular failure, uncorrected severe metabolic acidosis, sickle cell anemia, tricyclic antidepressant overdose, pregnancy)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Adaptive support ventilation in ARDS	type of mechanical ventilation	patients of ARDS will be randomized to this arm to receive mechanical ventilation as per ASV protocol
conventional ventilation strategy in ARDS	type of mechanical ventilation	-

Primary Outcome Measures

Name	Time	Method
Duration of mechanical ventilation	up to 4 weeks
duration of ICU stay	up to 4 weeks
duration of hospital stay	up to 8 weeks

Secondary Outcome Measures

Name	Time	Method
Mortality	up to 8 weeks
ease of use of ventilator mode	up to 4 weeks
frequency of blood gas analysis	up to 4 weeks

Trial Locations

Locations (1)

Respiratory intensive care unit, PGIMER; 🇮🇳 Chandigarh, India