Assessment of Occult Lung Stress During Lung Protective Mechanical Ventilation
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 入组人数
- 60
- 试验地点
- 2
- 主要终点
- Transpulmonary Driving Pressure
研究概览
简要总结
The present study will utilize esophageal manometry to measure the presence and magnitude of persistent patient effort during lung protective ventilation, allowing identification and mitigation of occult lung stress.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Intubated with a diagnosis of ARDS and expected to be ventilated for ≥ 48 hours
- •Meets Berlin criteria for ARDS, with or without underlying chronic lung disease
- •Triggering breaths on the ventilator
- •Treating medical team agrees with patient participation
排除标准
- •Known or suspected esophageal abnormalities, craniofacial abnormalities, or upper GI bleed
- •Shock that requires ≥ 2 vasopressors
- •pH on arterial blood gas ≤7.25
- •Minute ventilation ≥ 14L/min
- •Known or suspected pneumothorax, pneumomediastinum, and/or subcutaneous emphysema
- •Severe ARDS with P/F ratio <60
- •Pregnancy
- •Currently receiving extracorporeal membrane oxygenation (ECMO) therapy
- •Decision to withhold life-sustaining treatment
- •Patients who are not expected to survive for 24 hours
- •Lack of informed consent
结局指标
主要结局
Transpulmonary Driving Pressure
时间窗: Up to Hour 2 (Day 1)
Transpulmonary driving pressure is the pressure difference between the airway opening and pleural surface. It represents lung stress and is higher with increased spontaneous respiration and work of breathing.
Driving Pressure
时间窗: Up to Hour 2 (Day 1)
Driving pressure is defined as plateau pressure minus positive end-expiratory pressure (PEEP). Driving pressure during mechanical ventilation is directly related to stress forces in the lung.
Work of Breathing (WOB)
时间窗: Up to Hour 2 (Day 1)
WOB is the amount of energy or oxygen (O2) consumption needed by the respiratory muscles to produce enough ventilation and respiration to meet the metabolic demands of the body.
Pressure-Time Product (PTP)
时间窗: Up to Hour 2 (Day 1)
PTP is the product of the average inspiratory pressure (starting from the onset of effort) and the duration of inspiration. The PTP was developed to account for energy expenditures during the dynamic and isometric phases of respiration.
次要结局
- Lung Compliance (C, l)(Up to Hour 2 (Day 1))
- Respiratory System Compliance (C, rs)(Up to Hour 2 (Day 1))
- Chest Wall Compliance (C, cw)(Up to Hour 2 (Day 1))
- Oxygen Saturation(Up to Hour 2 (Day 1))
- PaO2/FiO2 (P/F) Ratio(Up to Hour 2 (Day 1))