Respiratory System Mechanics and Gas Exchange Characteristics Applying Different Ventilatory Strategies in Patients With SARS-CoV-2
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 15
- 试验地点
- 1
- 主要终点
- Driving transpulmonary pressure (cmH2O)
研究概览
简要总结
The combination of different ventilatory strategies and its effects on respiratory mechanics and gas exchange in patients under mechanical ventilation with acute respiratory distress syndrome secondary to coronavirus-19 has been scarcely described.
详细描述
Investigation in mechanically ventilated patients with with acute respiratory distress syndrome (ARDS) secondary to coronavirus-19 (COVID-19) is emerging due to presumed differences with typical ARDS from other origin. Considering these issues, the effects of ventilatory strategies such as positive end expiratory pressure, end inspiratory pause and fraction of inspired oxygen on respiratory mechanics and gas exchange must be studied in order to characterize the behavior of COVID-19 ARDS during invasive mechanical ventilation and choose the best combination of ventilatory settings.
In this study the investigators will evaluate the changes in respiratory mechanics and gas exchange produced by low and high positive end expiratory pressure, low and high inspired oxygen fraction and the application of end inspiratory pause during volume controlled mechanical ventilation.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Crossover
- 时间视角
- Cross Sectional
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
- •Older than 18 years old
- •less than 72 hs since ARDS diagnosis
- •Moderate to severe ARDS
- •central venous catheter and arterial line available
- •Need of neuromuscular blocking agents
- •Supine position
- •Informed consent accepted
- •Airway opening pressure lower than 20 cmH2O
排除标准
- •RASS target higher than -5
- •COPD diagnosis
- •Pneumothorax
- •Intracraneal Hypertension
- •Pregnancy
- •Cardiac inssuficiency uncompensated
- •Chest wall deformity
- •Bronchopleural fistula
- •Contraindication to use esophageal manometry
结局指标
主要结局
Driving transpulmonary pressure (cmH2O)
时间窗: 10 minutes
The driving transpulmonary pressure will be evaluated between the high and low PEEP condition using the formula: driving transpulmonary pressure = driving airway pressure - driving esophageal pressure (cmH2O).
Bohr dead space fraction (%)
时间窗: 10 minutes
The Bohr dead space fraction will be evaluated with high PEEP between the condition with end inspiratory pause and with no end inspiratory pause application using the formula: Bohr dead space fraction = Alveolar pressure of CO2 (PACO2) - Expired pressure of CO2 (PECO2) / PACO2
Shunt fraction (%)
时间窗: 10 minutes
The shunt fraction will be evaluated with low PEEP between the condition with high fraction of oxygen to achieve a saturation goal of 96-98% and the condition with low fraction of oxygen to achieve a saturation goal of 88-92%. The shunt fraction will be calculated using the formula: Qs/Qt = (capillary oxygen content - arterial oxygen content)/(capillary oxygen content - venous oxygen content)
次要结局
未报告次要终点
研究者
Matias Accoce
Head of physical therapy department
Sanatorio Anchorena San Martin