Effects of Mechanical Ventilation on Controlled Volume, Controlled Pressure and Pressure Support in the Immediate Postoperative Period of Cardiac Surgery on Pulmonary Electrical Impedance and Patient-ventilator Asynchrony: a Parallel Clinical Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 19
- 试验地点
- 2
- 主要终点
- electrical impedance measures
研究概览
简要总结
This study evaluates the effects of VCV, PCV and PSV ventilatory modes during the immediate postoperative period on the variables resulting from regional and global pulmonary electrical impedance and diaphragmatic mobility, as well as perform ventilator synchrony analysis in PSV mode by mechanical ventilator. Half of the participants will receive VCV followed by PSV for weaning, while the other half will receive PCV followed by PSV for weaning.
详细描述
In the immediate postoperative period of cardiac surgery, patients are found under mechanical ventilatory support. Commonly, they are ventilated in controlled and assisted-controlled volume (VCV) or pressure (PCV) modes, with weaning at pressure support (PSV).
Systematic reviews indicate that there is no difference between the VCV and PCV ventilatory modes for some clinical outcomes or that the existing evidence is insufficient. The distribution of regional ventilation and diaphragmatic mobility can be measured from the use of electrical impedance tomography (EIT) and diaphragmatic ultrasonography (US) to clarify the physiological changes and / or mechanisms of adaptation of the organism submitted to controlled modes cycled at volume or at pressure and spontaneously flow cycled mode.
Besides EIT and US measures, gasometric, hemodynamic and respiratory data will also be recorded. The statistical analysis will be considered α≤0.05 for a statistically significant difference.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Diagnostic
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •IMC 18.5-29.9 kg/m²
- •Two thoracic tubes (one mediastinal and one left-sided pleural)
- •under mechanical ventilation after surgery
- •submitted to intraoperative extracorporeal circulation
排除标准
- •Over 2h of cardiopulmonary bypass
- •Over 12h of post-operative mechanical ventilation
- •Post-operative bleeding above 500 ml in the first hour or above 300 ml in the first two hours
- •History of special conditions (neuromuscular and chronic pulmonary disease, thoracic deformity, abdominal distension).
研究组 & 干预措施
VCV+PSV
volume controlled cycled, assisted-controlled cycled ventilation mode + pressure support ventilation mode. Progression of invasive ventilatory assistance as the patient recovers during post-surgery.
干预措施: VCV+PSV (Device)
PCV+PSV
pressure controlled cycled, assisted-controlled cycled ventilation mode + pressure support ventilation mode. Progression of invasive ventilatory assistance as the patient recovers during post-surgery.
干预措施: PCV+PSV (Device)
结局指标
主要结局
electrical impedance measures
时间窗: 5 minutes of recording at each step of mechanical ventilation progression before extubation.
impedance variation data recorded by a tomograph.
次要结局
- arterial gas blood analysis data(up to 12h, following routine care while patients are mechanically ventilated)
- patient-ventilator synchrony(5 minutes of recording at each step of mechanical ventilation progression before extubation)
研究者
Wagner Souza Leite
Master's Program student
Universidade Federal de Pernambuco