Effect of Volatile Sedation on Spontaneous Breathing During Mechanical Ventilation for Patients With the Acute Respiratory Distress Syndrome
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 入组人数
- 20
- 试验地点
- 2
- 主要终点
- Respiratory drive (P0.1)
研究概览
简要总结
This study will investigate how different types of routine sedation may affect patient's breathing whilst on a ventilator in the Intensive Care Unit (ICU). There are different approaches to sedation which may have advantages and disadvantages. During the study patients will receive both intravenous and inhaled volatile sedation (similar to anaesthetic 'gases' used for general anaesthesia) and the drive to breath, breathing efforts and function of the lung will be assessed.
详细描述
It is routine for patients to be sedated for their comfort and safety whilst on a ventilator in the Intensive Care Unit (ICU). Conventionally sedatives are given intravenously, however inhaled volatile sedation is becoming more popular. Inhaled sedation has recently been approved by the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom (UK).
Whilst being on a ventilator can be life-saving, it can cause potential problems. It is important that the patient interacts well with the ventilator and that their own breathing efforts are well regulated. There is evidence that inhaled sedation can specifically help the lungs when patients have the Acute Respiratory Distress Syndrome (ARDS) and in particular, inhaled sedation does not appear to suppress patient's own breathing as much as conventional sedation. Greater spontaneous breathing by the patient is usually positive but needs to be carefully understood to ensure it is not excessive or damaging to the patient's already injured lungs.
This study of 20 patients is designed to carefully measure the impact of inhaled sedation on the patient's breathing and lung function, in comparison to intravenous sedation. Measurements will be taken whilst on intravenous sedation before the patient is switched to an equivalent level of inhaled sedation for six hours, when the measurements will be repeated. Finally, the patient will go back to their original intravenous sedation and the measurements taken again. This is called a 'cross-over' study and is a good way to evaluate the effect of the drug.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Crossover
- 主要目的
- Basic Science
- 盲法
- None
盲法说明
None, open label, physiological study
入排标准
- 年龄范围
- 17 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients admitted to the Intensive Care Unit (ICU)
- •Invasive mechanical ventilation (IMV)
- •Spontaneous breathing in pressures support mode (PSV) for less than or equal to 48 hours
- •Sedated with intravenous sedation (ie. propofol and / or midazolam and fentanyl or alternate short acting opioid)
- •Anticipated to remain on IMV and PSV and with a stable sedation score for a further 24 hours without planned sedation interruption / spontaneous breathing trial or other significant change in the level of ventilator support
- •Not receiving / anticipated to receive paralysis
- •In supine position
排除标准
- •Personal or family history of malignant hyperpyrexia
- •Known or suspected elevated intracranial pressure
- •High dose vasopressors (ie. Noradrenaline > 0.3mcg/kg/min or equivalent)
- •Contra-indication to oesophageal balloon (i.e. oesophageal / upper gastro-intestinal pathology)
- •Pregnancy
- •High dose oral sedatives (e.g. benzodiazepines) or opioids (e.g. oxycodone / oral morphine) which may affect respiratory drive
研究组 & 干预措施
Conventional intravenous sedation
Conventional intravenous sedation (e.g. propofol) with short acting opioid, titrated to a clinically prescribed sedation score. Period of observation will be 2 hours pre-cross over and 2 hours post cross over.
干预措施: Propofol (Drug)
Inhaled volatile sedation
Inhaled volatile sedation (Isoflurane) delivered via the AnaConDa device for a 6 hour period (2 hours washout of intravenous sedation / wash-in of volatile to achieve stable baseline, followed by 4 hours of observations at steady state) titrated to an equivalent sedation score. During this period opioid infusion should be maintained at baseline level unless clinical indication for titration of dose.
干预措施: Isoflurane (Drug)
结局指标
主要结局
Respiratory drive (P0.1)
时间窗: 8 hours
Negative pressure in the first 100milliseconds of inspiration (P0.1) - Physiological parameter
次要结局
- Respiratory effort (PMI)(8 hours)
- Respiratory effort (Oesophageal pressure swings)(8 hours)
- Gas exchange (PaO2:FiO2 ratio)(8 hours)
- Gas exchange (volume of carbon dioxide breathed out (VCO2))(8 hours)
- Respiratory effort (Pmus)(8 hours)
- Gas exchange (pulmonary shunt fraction (Qs/Qt))(8 hours)
- Gas exchange ( ratio of ventilatory 'dead space' to tidal volume (Vd/Vt))(8 hours)