Baseline Ventilatory Parameters in Patients With Acute Neurological Injury
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 19
- 试验地点
- 2
- 主要终点
- Correlation between acute neurological injury and mechanical power normalized to predicted body weight
研究概览
简要总结
The goal of this observational study is to test the association between baseline ventilatory parameters (in particular mechanical power (MP), mechanical power normalized to predicted body weight (MP/PBW) and driving pressure (DP) with the baseline neurological status (assessed through the Glasgow coma score) in adults patients under mechanical ventilation with acute neurological injury secondary to stroke, brain trauma or subarachnoid hemorrhage.
The main question[s]it aims to answer are:
- In patients with acute neurological injury under mechanical ventilation, is there a correlation between the acute neurological injury, assessed using the Glasgow scale on admission, and baseline ventilatory parameters?
- In patients with acute neurological injury under mechanical ventilation, are the baseline ventilatory parameters altered at baseline?
详细描述
Adults patients with acute neurological injury (ANI) secondary to stroke, brain trauma or subarachnoid hemorrhage may present extraneurological complications. They occur as a consequence of the release of inflammatory mediators in an altered blood-brain barrier, which reach the circulation and thus alter the functionality of other organs. Of the affected organs, the lung is the most frequently compromised, leading to increased morbidity, mortality, and worse neurological outcomes. It should be noted that a large proportion of patients with ANI require mechanical ventilation (MV), which also through the production of inflammatory mediators, can lead to the development of ventilator-induced lung injury (VILI) and alteration of other organs.
From the above, it can be thought that in patients with ANI, the basal respiratory parameters could be altered and this is important, given that in this group of patients, the ventilatory parameters could generate changes at the brain level, particularly an increase in intracranial pressure (ICP) and variation in PaCO2 that would produce changes in the vasculature and concomitantly in cerebral blood flow. In turn, the use of protective ventilation, recommended in other pathologies such as acute respiratory distress syndrome (ARDS), is not clearly defined for this group of patients. For this reason, the objective of this study is the assessment of baseline ventilatory parameters in patients with ANI, in particular mechanical power (MP), mechanical power normalized to predicted body weight (MP/PBW) and driving pressure (DP) and to determine their association with the baseline neurological status (assessed through the Glasgow coma score). The hypothesis of the study, assuming that the greater the initial neurological damage, the greater the ventilatory alterations, is that MP correlates with the degree of neurological injury. The second hypothesis is that ventilatory variables, particularly MP, are altered at baseline in patients with LNA.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 16 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Acute neurological injury in patients ≥ 16 years of age with requiring mechanical ventilation for neurological causes and without baseline lung injury, defined as: normal chest x-ray and adequate oxygenation; PaO2/FiO2 ≥ 300.Neumovent TS and Neumovent Advance respirators will be used.
排除标准
- •Pneumothorax, or a pleural drainage tube. Hemodynamic instability (mean blood pressure ≤ 65 mmHg) or high doses of inotropes (Norepinephrine > 0.5 gammas/kilo/minute or equivalent).
- •PaO2/FiO2 < 80 mmHg. Chronic obstructive pulmonary disease (COPD). Pregnant
结局指标
主要结局
Correlation between acute neurological injury and mechanical power normalized to predicted body weight
时间窗: The first 2 days of the patient on mechanical ventilation (MV)
To determine the degree of correlation between acute neurological injury, assessed using the Glasgow coma score \[GCS; with a score between 3 (worst score, most severe) and 15 (best score, least severe)\] and mechanical power normalized to predicted body weight (Joules/minute/kilograms)
次要结局
- To assess the respiratory system resistance according to the different subgroups of ANI(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the static pressure according to the different subgroups of ANI(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the static compliance(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the dynamic driving pressure(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the dynamic driving pressure according to the different subgroups of ANI(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the mechanical power normalized to predicted body weight according to the different subgroups of ANI(The first 2 days of the patient on mechanical ventilation (MV))
- Correlation between acute neurological injury and mechanical power(The first 2 days of the patient on mechanical ventilation (MV))
- To assess static pressure(The first 2 days of the patient on mechanical ventilation (MV))
- To assess mechanical power normalized to predicted body weight(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the driving pressure according to the different subgroups of ANI(The first 2 days of the patient on mechanical ventilation (MV))
- Correlation between acute neurological injury and ΔP(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the driving pressure(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the static compliance according to the different subgroups of ANI(The first 2 days of the patient on mechanical ventilation (MV))
- To assess the respiratory system resistance(The first 2 days of the patient on mechanical ventilation (MV))
研究者
Roberto Santa Cruz
Principal Investigator
Ramos Mejía Hospital