Capnodynamic Monitoring of Cardiorespiratory Function in Patients Admitted to the Intensive Care Unit With COVID-19 Infection, Sepsis and Following Cardiac Surgery
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 100
- 试验地点
- 1
- 主要终点
- Prediction by capnodynamic monitoring of combined changes in end expiratory lung volume and effective pulmonary blood flow to assess changes in pulmonary gas exchange during various levels of PEEP
研究概览
简要总结
Capnodynamic monitoring has the potential to offer continuous and non-invasive measurements of heart and lung function in patients requiring ventilation in an intensive care setting. Since mechanical ventilation with full patient synchronization is commonly used in ICU, capnodynamic monitoring can be immediately embedded in clinical care and compared to current methods of monitoring cardiac output, lung volumes and oxygen delivery. This observational study will explore capnodynamic monitoring in mechanically ventilated patients with a range of cardiorespiratory compromise.
详细描述
This study aims to:
- compare the estimation of cardiac output (CO) using the capnodynamic method (COEPBF) with contemporary reference methods;
- compare the estimation of mixed venous oxygen saturation (SmvO2) with invasively obtained blood gas analyses;
- generate observational data on end-expiratory lung volume (EELV) when ventilator settings, and in particular PEEP, are changed;
- combine 1-3 to provide a physiological construct of cardiorespiratory function
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
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
- •Respiratory tract infection:
- •confirmed or highly suspected viral or bacterial pneumonia
- •meeting ARF or ARDS criteria as outlines in the most recent Berlin ARDS consensus statement
- •age 18 years or above
- •arterial and central venous catheters have been inserted or will be inserted as part of routine clinical management
- •mechanical ventilation via an endotracheal tube is expected to continue for the day beyond day of admission
- •adequate transthoracic echocardiographic winds are available to measure the velocity time integral in the left ventricular outflow tract
- •analgosedation is administered as part of routine management of residual neuromuscular blockaded initiated outside ICU OR the administration of analgosedation and/or neuromuscular blockers at doses that achieve full patient-ventilator synchrony are considered part of routine clinical management
- •admitted to ICU with a provisional or established diagnosis of septic shock as defined by the Sepsis-3 criteria
- •age 18 years or above
- •arterial and central venous catheters have been inserted or will be inserted as part of routine clinical management
- •mechanical ventilation via an endotracheal tube is expected to continue for at least another two hours
- •adequate transthoracic echocardiographic winds are available to measure the velocity time integral in the left ventricular outflow tract
- •analgosedation is administered as part of routine management of residual neuromuscular blockaded initiated outside ICU OR the administration of analgosedation and/or neuromuscular blockers at doses that achieve full patient-ventilator synchrony are considered part of routine clinical management
- •the administration of a fluid bolus (250 ml or 500 ml) is indicated as judged by the medical officer supervising routine management
- •Cardiac surgery:
- •admitted to ICU following cardiac surgery using cardiopulmonary bypass
- •age 18 years and above
- •arterial, central venous and pulmonary arterial catheters have been inserted or will be inserted as part of routine clinical management
- •mechanical ventilation via an endotracheal tube is expected to continue for at least another two hours
- •analgosedation is administered as part of routine management of residual neuromuscular blockade initiated intraoperatively OR the administration of analgosedation and/or neuromuscular blockers at doses that achieve full patient-ventilator synchrony are considered part of routine clinical management
- •the administration of a fluid bolus (250 ml or 500 ml) is indicated as judged by the medical officer supervising routine postoperative management
排除标准
- •In all cohorts:
- •age under 18 years
- •known pregnancy
- •arterial and central venous catheters are not indicated as part of routine care
- •known severe valvulopathy
- •ongoing or imminent need for mechanical circulatory support
- •severe haemodynamic instability with imminent transfer for intervention(s) outside ICU
- •patient is not for full active management in ICU
- •patient is not expected to live beyond the day of admission
- •patient is re-admitted to ICU within the same index hospital admission
- •it is not possible to achieve full patient-ventilator synchrony
结局指标
主要结局
Prediction by capnodynamic monitoring of combined changes in end expiratory lung volume and effective pulmonary blood flow to assess changes in pulmonary gas exchange during various levels of PEEP
时间窗: Through study completion, an average of 1 year
At three different levels of PEEP, the interactions between end expiratory lung volume and effective pulmonary blood flow will be assessed and correlated to changes in arterial partial pressure of oxygen and carbon dioxide
Correlation between capnodynamic estimates of mixed venous oxygen saturation and blood gas analysis of blood obtained from the pulmonary artery pulmonary.
时间窗: Through study completion, an average of 1 year
Capnodynamic estimates of mixed venous oxygen saturation are compared with contemporaneously obtained blood gases from the pulmonary artery catheter
Correlation between capnodynamic effective pulmonary blood flow and cardiac output measured by pulmonary artery thermodilution or echocardiography
时间窗: Through study completion, an average of 1 year
Capnodynamic measurements of effective pulmonary blood flow are compared with contemporaneously obtained cardiac output measurements using clinical reference methods
次要结局
未报告次要终点
研究者
Anders Aneman
Conj Professor UNSW, Director ICU Research, Senior Staff Specialist
South West Sydney Local Health District