Effects of Remifentanil Based Sedation on Patient-ventilator Interaction, in Patients Undergoing Noninvasive Ventilation (NIV)
Overview
- Phase
- Not Applicable
- Intervention
- Remifentanil
- Conditions
- Acute Hypercapnic Respiratory Failure
- Sponsor
- IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Enrollment
- 15
- Locations
- 1
- Primary Endpoint
- patient-ventilator interaction
- Last Updated
- 9 years ago
Overview
Brief Summary
In patients undergoing NIV for acute respiratory, lack of tolerance is one of the main reason of failure.
This may result in a poor synchrony between the patient and the machine, leading to gross mismatching and potentially to an increased work of breathing.
The investigators aim to investigate whether in these patients poorly responding to NIV the use of a sedation protocol using remifentanil will lead to an improve patient-ventilator interaction and better compliance to NIV.
Detailed Description
In patients undergoing NIV for acute respiratory, lack of tolerance is one of the main reason of failure. This may result in a poor synchrony between the patient and the machine, leading to gross mismatching and potentially to an increased work of breathing. The investigators aim to investigate whether in these patients poorly responding to NIV the use of a sedation protocol using remifentanil will lead to an improve patient-ventilator interaction and better compliance to NIV. In this physiological study the investigators will study 15 patients at risk of failing NIV because of scarce tolerance and showing clinical signs of poor interaction with the ventilator. Once the patient will be enrolled the investigators will record using the balloon-catheter technique the online measurement of respiratory mechanics, to assess the inspiratory muscle effort and the matching between the patient breathing pattern and that of the ventilator The investigators will also record the clinical success of sedation (i.e. need or not for endotracheal intubation)
Investigators
dr. Stefano Nava
Professor of Respiratory Medicine
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Eligibility Criteria
Inclusion Criteria
- •Ph\<7,35 and PaCO2\>50 mmHg with acute respiratory failure
- •Signs of respiratory distress and poor synchrony with the ventilator as assessed on the ventilator screen and by looking patient own rate and ventilator recorded rate
Exclusion Criteria
- •Patients responding well to NIV and not showing signs of poor synchrony
Arms & Interventions
acutely ill patients
administration of remifentanil at the infusion rate by 0.025 μg kg-1 min-1 to a maximum of 0.10 μg kg-1 min-1.
Intervention: Remifentanil
Outcomes
Primary Outcomes
patient-ventilator interaction
Time Frame: one hour
patient-ventilator interaction will be assessed using the recording of respiratory mechanics to identify
Wasted efforts
Time Frame: one hour
breaths unable to trigger the ventilator
matching of inspiratory timing
Time Frame: one hour
the patients inspiratory time vs ventilator inspiratory time
Secondary Outcomes
- NIV failure(one hour)