Alveolar Recruitment in Brain Injury

Status Completed

Clinical Trial Summary

Development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in patients with severe brain injury has been associated with poor outcome. The application of lung recruitment maneuvers (RM) for a short period of time to open collapsed alveoli and reverse hypoxemia in early ARDS has been recommended. However, little is known about the cerebral and vascular effects of RM in brain injury patients with ALI/ARDS. The aim of this study is to assess the effects of a single standardized RM on oxygenation and on systemic and cerebral hemodynamics in severe brain injury patients with ALI/ARDS.

Clinical Trial Description

Patients with severe brain injury comprise a significant portion of admissions to critical care units. These patients are unable to adequately protect their airways and are usually intubated and mechanically ventilated. The goal of mechanical ventilation in patients with brain injury is to optimize blood gas exchange while minimizing intrathoracic pressure to avoid interference with cerebral venous drainage.Over the last 20 years, a plethora of experimental and clinical data have shown that mechanical ventilation can cause or aggravate lung damage in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). The aim of this pilot study was to assess the effects of a single standardized recruitment maneuver (RM) on oxygenation and on systemic and cerebral hemodynamics in severe brain injury patients with ALI/ARDS.

Only patients with brain injury, as defined by a Glasgow Coma Score <13, admitted into the Trauma and Surgical intensive care unit (ICU) will be studied.

After obtaining informed consent, a RM will be performed by switching the ventilator from assist/control ventilation to continuous positive airway pressure (CPAP) and applying a pressure of 40 cmH2O for 40 sec (11). After the RM, patients have been ventilated in pressure control ventilation and PEEP will be gradually reduced in decremental steps every 3 respiratory cycles starting with PEEP at 30 cm H2O, maintaining a maximum peak pressure of 40 cmH2O during this procedure until pre-RM PEEP levels are achieved. The RM will be discontinued if any of the following changes developed during the procedure: (i) ≥20% changes in baseline systemic blood pressure, (ii) ICP ≥20 mmHg, or (iii) SaO2 ≤90%. After the RM is performed, respiratory mechanics, arterial and SjO2 blood samples and systemic and cerebral hemodynamics will be obtained at 30 min and 8 hours. ;

Study Design

Observational Model: Case-Only, Time Perspective: Prospective

Related Conditions & MeSH terms

Acute Lung Injury
Brain Injuries
Brain Injury
Lung Injury
Respiratory Distress Syndrome, Adult

Clinical Trial Details

NCT number	NCT01159392
Study type	Observational
Source	Hospital Clinic of Barcelona
Contact
Status	Completed
Phase	N/A
Start date	February 2001
Completion date	November 2003

View Details

See also
Status	Clinical Trial	Phase
Recruiting	`NCT03937947` - Traumatic Brain Injury Associated Radiological DVT Incidence and Significance Study
Completed	`NCT04247477` - Comparison of Different PEEP Titration Strategies Using Electrical Impedance Tomography in Patients With ARDS	N/A
Completed	`NCT03315702` - Effect of Mechanical Ventilation on Plasma Concentration Level of R-spondin Proteins
Not yet recruiting	`NCT02693912` - Changes in Alveolar Macrophage Function During Acute Lung Injury	N/A
Completed	`NCT01659307` - The Effect of Aspirin on REducing iNflammation in Human in Vivo Model of Acute Lung Injury	Phase 2
Completed	`NCT01552070` - Recruitment on Extravascular Lung Water in Acute Respiratory Distress Syndrome (ARDS)	Phase 2
Unknown status	`NCT01186874` - Epidemiology Research on Acute Lung Injury/Acute Respiratory Distress Syndrome (ALI/ARDS) in Adult ICU in Shanghai	N/A
Withdrawn	`NCT00961168` - Work of Breathing and Mechanical Ventilation in Acute Lung Injury	N/A
Recruiting	`NCT00759590` - Comparison of Two Methods to Estimate the Lung Recruitment	N/A
Completed	`NCT02475694` - Acute Lung Injury After Cardiac Surgery: Pathogenesis	N/A
Completed	`NCT00736892` - Incidence of Acute Lung Injury: The Alien Study
Completed	`NCT00825357` - Biological Markers to Identify Early Sepsis and Acute Lung Injury	N/A
Terminated	`NCT00263146` - Recruitment Maneuvers in ARDS: Effects on Respiratory Function and Inflammatory Markers.	N/A
Completed	`NCT00188058` - Comparison of 2 Strategies of Adjustment of Mechanical Ventilation in Patients With Acute Respiratory Distress Syndrome	N/A
Completed	`NCT00234767` - Study of the Economics of Pulmonary Artery Catheter Use in Patients With Acute Respiratory Distress Syndrome (ARDS)	Phase 3
Recruiting	`NCT02598648` - Role and Molecular Mechanism of Farnesoid X Receptor(FXR) and RIPK3 in the Formation of Acute Respiratory Distress Syndrome in Neonates	N/A
Recruiting	`NCT02948530` - Measurement of Lung Elastance and Transpulmonary Pressure Using Two Different Methods (Lungbarometry)
Completed	`NCT01532024` - Exploratory Clinical Study of Neutrophil Activation Probe (NAP) for Optical Molecular Imaging in Human Lungs	Early Phase 1
Recruiting	`NCT01992237` - Measuring Energy Expenditure in ECMO (Extracorporeal Membrane Oxygenation) Patients	N/A
Completed	`NCT01486342` - PET Imaging in Patients at Risk for Acute Lung Injury	N/A