Prediction of Response to Recruitment Maneuvers in Patients With Acute Respiratory Failure
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 14
- 试验地点
- 2
- 主要终点
- Significant reduction in silent spaces (i.e. non ventilated lung areas) during incremental PEEP steps
研究概览
简要总结
The study will explore the possibility to predict potential for recruitment in acute hypoxemic respiratory failure patients by electrical impedance tomography (EIT) Swisstom BB2 (Swisstom, Landquart, Switzerland) during stepwise increase in positive end-expiratory pressure (PEEP) followed by recruitment maneuver (RM). It will compare data obtained by EIT to those obtained by pressure-volume (P-V) curves on respiratory system mechanics and data on pulmonary gas exchange.
详细描述
The investigators will monitor lung ventilation by EIT during the whole protocol and perform P-V curves and arterial blood gas analysis at every step of the protocol.
Participants will be sedated and paralyzed, ventilated in volume-controlled with protective ventilation (tidal volume=6-8 mL/Kg of predicted body weight and respiratory rate set to obtain normal pH) then the protocol will follow 5 steps each lasting 20 minutes to obtain clinical stability:
- PEEP 5 centimeter of water (cmH2O)
- PEEP 10 cmH2O
- Recruitment maneuver followed by PEEP 15 cmH2O
- PEEP 10 cmH2O
- PEEP 5 cmH2O
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Diagnostic
- 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
- •Patients with acute hypoxemic respiratory failure defined by recent known clinical insult or worsening of respiratory symptoms and arterial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) ≤300 mmHg
- •Patient on invasive mechanical ventilation
- •Age ≥18 years
- •Written informed consent
排除标准
- •Pregnancy
- •Unstable hemodynamic condition requiring blood transfusion or adjustment of inotropics more often than every hour
- •FiO2 ≥80% or clinical suspicion of pulmonary embolism
- •Pneumothorax
- •Chronic obstructive pulmonary disease (COPD) with clinical symptoms of lung emphysema as evidenced by chest radiography or computed tomography or autoPEEP > 5 cmH2O
- •Intracranial hypertension
- •Impossibility to correctly position the EIT belt (e.g., dressings, chest drainage, etc.)
- •Contraindications to EIT (e.g., implantable cardiac defibrillator, pacemaker, instable spinal lesions)
结局指标
主要结局
Significant reduction in silent spaces (i.e. non ventilated lung areas) during incremental PEEP steps
时间窗: Within 20 minutes from PEEP increase
次要结局
未报告次要终点
研究者
Savino Spadaro
Researcher
Università degli Studi di Ferrara