Biphasic Intermittent Positive Airway Pressure (BIPAP) Versus Airway Pressure Release Ventilation (APRV) in Patients With Multiple Fracture Ribs
试验速览
- 阶段
- 不适用
- 入组人数
- 60
- 试验地点
- 1
- 主要终点
- Duration of mechanical ventilation
研究概览
简要总结
Chest trauma is the most common injury in the emergency trauma and rib fractures is the most common trauma in chest trauma. Severe rib fractures can cause paradoxical respiration and mediastinal swing, which has large effects on respiratory and circulatory system, result in acute respiratory distress syndrome. Mechanical ventilation can significantly improve the hypoxemia of the patients, correct paradoxical respiration, and treat the pulmonary atelectasis
详细描述
To compare between Biphasic Intermittent Positive Airway Pressure (BIPAP) ventilation and Airway Pressure Release Ventilation (APRV) mode in patients with multiple fracture ribs as regard:
- Resting Energy Expenditure
- Oxygenation
- Stability of Physiological Status as cardiovascular activity
- cardiac output
- arterial blood gas measurement including [ blood PH, arterial oxygen tension, arterial carbon dioxide tension, bicarbonate level and base deficit]
- lung and chest compliance
- Length of intensive care unit stay.
- The ICU mortality rate.
- The development of major complications as nosocomial infection (hospital acquired pneumonia and ventilator associated pneumonia), major atelectasis and pneumothorax.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Isolated chest trauma patient with Multiple fracture ribs patients [ >3 ribs] who will be admitted to the surgical ICU for ventilatory support and will be expected to continue for 2 days or longer
排除标准
- •Age < 18 years old.
- •Pregnant patient.
- •Patient who will require fraction of inspired oxygen more than 0.
- •Air leak from the chest tube.
- •Patient with body temperature > 39 Celsius.
- •Acute hepatitis or severe liver disease (Child-Pugh class C).
- •Left ventricular ejection fraction less than 30%.
- •Heart rate less than 50 beats/min.
- •Second or third-degree heart block.
- •Systolic pressure < 90 mmHg despite of infusion of 2 vasopressors.
- •Patients with known endocrine dysfunction.
- •Patient with hypothermia
- •Patient on Positive end expiratory pressure more than 14 cmH2o
研究组 & 干预措施
Group 1
Biphasic Intermittent Positive Airway Pressure (BIPAP) group:
Following endotracheal intubation BIPAP mode will be started with:
- Inspiratory positive airway pressure [IPAP] at 20 cmH2O
- Expiratory positive airway pressure [EPAP] at 5 cmH2O
- PRESSURE SUPPORT is difference between these two pressures [IPAP]- [EPAP]
- Mandatory pressure will be delivered at rate of 10-12/min. To produce an end tidal carbon dioxide partial pressure in the range of 35-40 mmHg hypercapnia will not be allowed
干预措施: Biphasic Intermittent Positive Airway Pressure (BIPAP) (Device)
Group 2
Airway Pressure Release Ventilation (APRV) group:
- high airway pressure (Phigh) will be set at 20 cmH2O
- low airway pressure ( Plow) will be set at 5 cmH2O
- the release phase setting will be adjusted to terminate the peak expiratory flow rate to ≥ 50%; release frequency of 10-12 cycles/min
- T high at 4.5-6 seconds
- T low at 0.5 to 0.8 second
干预措施: Airway Pressure Release Ventilation (APRV) (Device)
结局指标
主要结局
Duration of mechanical ventilation
时间窗: within one month
The total duration of ventilatory support in both groups from randomization to successful weaning (hours)
次要结局
- Physiological dead space(within the first 48 hours)
- Resting Energy Expenditure(within the first 48 hours)
研究者
Sayed Kaoud Abd-Elshafy
Associate Professor of Anesthesiology and Critical Care
Assiut University