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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03630510
Other study ID # VHI + Tins
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date March 18, 2017
Est. completion date March 28, 2018

Study information

Verified date August 2018
Source Brazilian Institute of Higher Education of Censa
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The investigators hypothesis is that the adjustment of the inspiratory time may optimize the distribution of ventilation and increase tidal volume, producing potential therapeutic effects on the displacement of secretions and respiratory mechanics. The objective of this study was To evaluate the effects of hyperinflation with the ventilator associated with increased inspiratory time on respiratory mechanics.


Description:

A randomized crossover clinical trial was conducted with 38 mechanically ventilated patients with pulmonary infection. The order of hyperinflation or control (without changes in parameters) was randomized. Hyperinflation was performed for 5 minutes in the controlled pressure ventilation mode, with progressive increases of 5cmH2O until reaching a maximum pressure of 35cmH2O, maintaining PEEP. After reaching 35cmH2O, the inspiratory time and respiratory rate were adjusted so that the inspiratory and expiratory flows reached the baseline, respectively. Static compliance (Cest, sr), total resistance (Rsr) and airway resistance (Rva), slow pressure drop (ΔP2) and peak expiratory flow (PEF) were assessed before (PRÉ), immediately after the maneuver (POSSimed) and after aspiration (POSPasp). Two-way ANOVA was used for repeated measurements with Tukey post-test, considering a significant p <0.05.


Recruitment information / eligibility

Status Completed
Enrollment 38
Est. completion date March 28, 2018
Est. primary completion date August 12, 2017
Accepts healthy volunteers No
Gender All
Age group 18 Years to 80 Years
Eligibility Inclusion Criteria:

- Patients under mechanical ventilation for more than 48h

- Mucus hypersecretion (defined as the need for suctioning < 2-h intervals)

Exclusion Criteria:

- Severe bronchospasm,

- Positive end expiratory pressure > 10cmH2O,

- PaO2-FiO2 relationship < 150,

- Mean arterial pressure < 60mmHg,

- Pleural effusion or pneumothorax undrained,

- Bronchopleural or tracheoesophageal fistula,

- Decompensated congestive heart failure.

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Ventilator hyperinflation
The ventilator hyperinflation maneuver with inspiratory time adjustment was performed in the pressure controlled ventilation mode (PCV). The inspiratory pressure was increased gradually every 5 cmH2O until reaching a maximum pressure of 35 cmH2O, according to the tolerance of the patient determined by the absence of cough. PEEP remained unchanged throughout the study. After reaching a maximum pressure of 35 cmH2O (PCV + PEEP level), the inspiratory time was gradually increased until the inspiratory flow reached the baseline. Concomitantly, the respiratory rate was decreased to allow the expiratory flow also to reach the baseline, to avoid self-PEEP. The maneuver was performed for 5 min, followed by tracheal aspiration.

Locations

Country Name City State
Brazil Luciano M Chicayban Campos Dos Goytacazes RJ

Sponsors (1)

Lead Sponsor Collaborator
Brazilian Institute of Higher Education of Censa

Country where clinical trial is conducted

Brazil, 

Outcome

Type Measure Description Time frame Safety issue
Primary Static compliance of respiratory system Compliance was assessed through the occlusion maneuver at the end of inspiration, considering tidal volume, plateau pressure and PEEP. Three measurements were taken at each moment, the mean being used. Baseline (before), immediately after VHI and five minutes after aspiration
Primary Total Resistance of respiratory system The total resistance of the respiratory system was evaluated through the occlusion maneuver at the end of the inspiration, considering the resistive pressure, measured by the difference between the maximum plateau pressure. Three measurements were taken at each moment, the mean being used. Baseline (before), immediately after VHI and five minutes after aspiration
Primary Airway Resistance The airway resistance was assessed by means of the occlusion maneuver at the end of the inspiration, considering the rapid fall of the pressure immediately after the occlusion, measured by the difference between the maximum pressure and P1. Three measurements were taken at each moment, the mean being used. Baseline (before), immediately after VHI and five minutes after aspiration
Primary Peak expiratory flow The peak expiratory flow was evaluated through passive expiration, being considered the greatest value of the flow in the expiratory phase. Baseline (before), immediately after VHI and five minutes after aspiration
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