Ventilator Hyperinflation and Hemodynamics
- Conditions
- Respiratory DisordersRespiratory Failure
- Registration Number
- NCT03557645
- Lead Sponsor
- Centro Universitário Augusto Motta
- Brief Summary
Ventilator hyperinflation (VHI) has been shown to be effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated patients; however, the literature is scarce concerning its safety and adverse effects. Thus, the aim of this study is to compare the hemodynamic repercussions of VHI in volume-controlled mode. In a randomized, controlled and crossover design, 24 mechanically ventilated patients will undergo 2 modes of ventilator hyperinflation (with and without an inspiratory pause) and a control intervention. Cardiac output, cardiac index, mean arterial pressure, pulmonary vascular resistance, systolic volume and other hemodynamic variables will be recorded during the interventions.
- Detailed Description
Background: ventilator hyperinflation (VHI) has been shown to be effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated patients; however, the literature is scarce concerning its safety and adverse effects. Thus, the aim of this study is to compare the hemodynamic repercussions of VHI in volume-controlled mode.
Methods: in a randomized, controlled and crossover design, 24 mechanically ventilated patients will undergo 2 modes of ventilator hyperinflation (with and without an inspiratory pause of 2 seconds) and a control intervention. For the VHI interventions, the inspiratory flow will be set at 20 Lpm, and tidal volume will be increased until a peak pressure of 40cmH2O is achieved. During the control intervention, the patients will remain in volume-control ventilation with an inspiratory flow = 60Lpm and tidal volume = 6mL/IBW. The interval between interventions (washout) will be of 10 minutes or more, according to the time needed to recover the cardiac index to baseline values (maximum difference of 10%). Cardiac output, cardiac index, mean arterial pressure, pulmonary vascular resistance, systolic volume and other hemodynamic variables will be recorded during the interventions by using impedance cardiography.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 17
- Patients under mechanical ventilation for more than 48h
- mucus hypersecretion (defined as the need for suctioning < 2-h intervals),
- absence of respiratory drive,
- atelectasis,
- severe bronchospasm,
- positive end expiratory pressure > 10cmH2O,
- PaO2-FiO2 relationship < 150,
- mean arterial pressure < 60mmHg,
- inotrope requirement equivalent to >15 ml/h total of adrenaline and noradrenalin,
- intracranial pressure > 20mmHg
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Primary Outcome Measures
Name Time Method Change in Cardiac Output Baseline (before) and 10 minutes after the onset of VHI modesBasel Estimation of cardiac output variation using thoracic bioimpedance
- Secondary Outcome Measures
Name Time Method Change in Systolic Volume II Baseline (before) and 5 minutes after the end of VHI modes Estimation of systolic volume variation using thoracic bioimpedance
Change in Vascular pulmonary resistance Baseline (before) and 10 minutes after the onset of VHI modes Estimation of vascular pulmonary resistance variation using thoracic bioimpedance
Change in Mean Arterial Pressure Baseline (before) and 10 minutes after the onset of VHI modes Recording of mean arterial pressure variation using an automatic noninvasive device
Change in Cardiac Index II Baseline (before) and 5 minutes after the end of VHI modes Estimation of cardiac index variation using thoracic bioimpedance
Change in Vascular pulmonary resistance II Baseline (before) and 5 minutes after the end of VHI modes Estimation of vascular pulmonary resistance variation using thoracic bioimpedance
Change in Mean Arterial Pressure II Baseline (before) and 5 minutes after the end of VHI modes Recording of mean arterial pressure variation using an automatic noninvasive device
Change in Cardiac Index Baseline (before) and 10 minutes after the onset of VHI modes Estimation of cardiac index variation using thoracic bioimpedance
Change in Systolic Volume Baseline (before) and 10 minutes after the onset of VHI modes Estimation of systolic volume variation using thoracic bioimpedance
Change in Cardiac Output II Baseline (before) and 5 minutes after the end of VHI modes Estimation of cardiac output variation using thoracic bioimpedance
Trial Locations
- Locations (1)
Hospital Santa Martha
🇧🇷Niterói, Rio De Janeiro, Brazil
Hospital Santa Martha🇧🇷Niterói, Rio De Janeiro, Brazil