Intubation Clinical Trial
Official title:
Pulmonary and Ventilatory Effects of Trigger Modulation in Intubated ICU Patients Spontaneously Breathing With Pressure Support Ventilation. A Physiopathology Exploratory Study.
Pressure support ventilation allows intubated ICU patients to breathe spontaneously. Among specific settings, the adjustment of the trigger value (or threshold for triggering the ventilator) has not been explored to date. The trigger threshold corresponds to the sensitivity of the ventilator to detect patient's inspiratory effort and then deliver the predefined pressure support to inflate the lungs and deliver a tidal volume. The purpose of this study is to explore the influence of trigger level on pulmonary and ventilatory physio (-patho)logical parameters in spontaneously breathing ICU patients.
The use of invasive mechanical ventilation is one of the most frequent therapies in intensive care units (ICUs). There are several types of indications, depending on the failure: essentially neurological, hemodynamic or respiratory. In recent years, the notion of lung damage induced by mechanical ventilation (VILI) has led to major changes in ventilator settings in both ICUs and operative rooms (Ors). The reduction of the tidal volume (TV) to 6-8 mL/kg of ideal body weight, the use of an individualized positive end-of-expiratory pressure (PEEP) and the possible use of pulmonary aeration optimization therapies (alveolar recruitment manoeuvres, prone positioning sessions...) have become essential to increase patient's survival. Withdrawal of invasive mechanical ventilation remains a daily issue and traditionally requires the transition from fully controlled ventilation to pressure support ventilation. Among specific settings of the latter, the adjustment of the trigger value (or threshold for triggering the ventilator) has not been explored to date. The trigger threshold corresponds to the sensitivity of the ventilator to detect patient's inspiratory effort and then deliver the predefined pressure support to inflate the lungs and deliver a tidal volume. The lower (or more sensitive) the trigger threshold, the smallest patient's effort will be rewarded. On the other hand, the higher the threshold, the greater the inspiratory effort required from the patient. Usually, this value is set by default to the minimum level to avoid self-triggering of the ventilator. With the objective to optimize pulmonary aeration, the use of higher trigger levels could increase diaphragmatic work (with a potential re-training and reinforcement effect) and contribute to better alveolar recruitment in the postero-inferior territories that are traditionally the most impacted, following a higher diaphragmatic motion. The authors propose to explore the impact of different trigger levels on pulmonary aeration (evaluated by electrical impedance tomography) and ventilatory parameters, in order to validate our hypotheses and before considering a trial with the objective of defining individualized trigger levels, according to patient's respiratory mechanics and pulmonary parenchyma morphology, with potential benefits on ventilator weaning. ;
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT03277872 -
NoL, HR and MABP Responses to Tracheal Intubation Performed With MAC Blade Versus Glidescope
|
N/A | |
Suspended |
NCT04253795 -
Nonintubated Versus Intubated Anesthesia in Video-assisted Thoracic Surgery
|
N/A | |
Completed |
NCT02864017 -
Immuno Nutrition by L-citrulline for Critically Ill Patients
|
N/A | |
Completed |
NCT02900807 -
CT-scan Airways Mensuration - Correlation to External Measurements
|
||
Completed |
NCT01823328 -
Ketamine Versus Etomidate for Rapid Sequence Intubation
|
Phase 4 | |
Completed |
NCT02350933 -
Endoscopic Evaluation of the Paediatric Airway After Prior Prolonged (>24 h) Tracheal Intubation
|
N/A | |
Completed |
NCT01170455 -
Nasal Intubation Using the Blind Intubation Device
|
N/A | |
Completed |
NCT00980590 -
Airway Scope and Macintosh Laryngoscope for Tracheal Intubation in Patients Lying on the Ground
|
N/A | |
Completed |
NCT05515107 -
The Laryngoscopic View With C-MAC Videolaryngoscope Miller Blade Lifting the Epiglottis or the Vallecula in Children
|
N/A | |
Completed |
NCT06249659 -
Impact of Extubation Location After Surgery on Perioperative Times
|
||
Completed |
NCT03677505 -
KoMAC Videolaryngoscope for Double-lumen Intubation
|
N/A | |
Completed |
NCT03328182 -
Assessment of an Oral Endotracheal Subglottic Tube Holder
|
N/A | |
Recruiting |
NCT02277652 -
Endotracheal Intubation Devices
|
N/A | |
Recruiting |
NCT02277405 -
Pediatric Intubation During Resuscitation
|
N/A | |
Recruiting |
NCT02073786 -
Rigid Video Stylet Vs Conventional Lightwand Intubation
|
N/A | |
Completed |
NCT02277418 -
Venner a.p. Advance Video Laryngoscope
|
N/A | |
Completed |
NCT01003327 -
Comparison of the I-gel Laryngeal Mask and the Classic Laryngeal Mask in Patients With a BMI>25
|
Phase 4 | |
Completed |
NCT00956592 -
Clinical Evaluation of the Storz CMAC Laryngoscope
|
N/A | |
Completed |
NCT00783731 -
Low Dose of Midazolam is Superior to Conventional Dose for Rapid Sequence Intubation in Emergency Department (ED)
|
N/A | |
Recruiting |
NCT03887897 -
First Attempt Intubation Rate With Airtraq vs Macintosh Direct Laryngoscope
|
N/A |