Effect of Mechanical Power on Dead Space Assessed by Volumetric Capnography: Preliminary Studies and Pilot Testing in ARDS Patients

  • STATUS
    Recruiting
  • participants needed
    7
  • sponsor
    Clinica las Condes, Chile
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Updated on 16 February 2024
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mechanical ventilation
positive end expiratory pressure
acute respiratory distress

Summary

This study assesses changes in physiological variables, aiming to determine whether a reduction in the mechanical power delivered by artificial ventilation while maintaining constant peep levels generates a reduction in the Bohrs dead space in patients with moderate to severe acute respiratory distress syndrome (ARDS). Commonly used ventilatory strategies aimed at reducing mechanical power will be applied sequentially to assess their impact. Data obtained from volumetric capnography will be recorded after each ventilatory strategy is applied.

Description

Invasive mechanical ventilation is the cornerstone of the management of patients with Acute Respiratory Distress Syndrome. However, studies have shown that increasing tidal volume and driving pressure leads to negatives outcomes. It has also been observed that an increase in the physiologic dead space is associated with significantly higher mortality. We designed this study to assess these physiological variables, aiming to determine whether the reduction in the mechanical power delivered by artificial ventilation generates a decrease of the Bohrs dead space in patients with moderate to severe ARDS. Therefore, this observational study will describe the effect that mechanical power has on Bohr's dead space and its subcomponents in mechanically ventilated patients with ARDS. Commonly used ventilatory strategies aimed at reducing mechanical power will be applied sequentially to assess their effects. Data obtained from volumetric capnography will be recorded after each ventilatory procedure is implemented. This observational study will be performed in the Intensive Care Unit of a University Hospital.

Protocol design: The protocol will start recording the data during baseline protective ventilation. After 30 minutes of data recording, we studied four levels of setting in mechanical ventilation. Each level will last 30 minutes.

We will analyze the last 20 breaths of each step of the protocol and calculate the average value to obtain the result of dead space and all its variables by volumetric capnography. Respiratory, hemodynamic, and arterial blood gas analysis will also be recorded.

Details
Condition ADULT RESPIRATORY DISTRESS SYNDROME, Volumetric Capnography, Mechanical Power
Age 18years - 100years
Clinical Study IdentifierNCT04435613
SponsorClinica las Condes, Chile
Last Modified on16 February 2024

Eligibility

 Yes No Not Sure

Inclusion Criteria

Age older than 18 years
The requirement of invasive mechanical ventilation for more than 4 hours and less than 72 hours
Severe hypoxemia (PAFI < 200) secondary to ARDS

Exclusion Criteria

Heart failure stage IV
Chronic obstructive pulmonary disease (COPD) on home oxygen
Bronchopulmonary fistula
Hypovolemic Shock with active hemorrhage
Gastrointestinal bleeding
Oesophageal Varices
Nasopharynx surgery, recent oesophageal or gastric surgery
Massive Pulmonary Thromboembolism
Catastrophic respiratory failure requiring urgent extracorporeal life support
Respiratory acidosis. Hydrogen potential (pH) is less than 7.20 and PaCO2 higher than 60 mmHg at baseline
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