Ventilation Therapy; Complications Clinical Trial
Official title:
Physiological Dead Space Measured by Volumetric Capnography, Is it Different Between the Biphasic Positive Airway Pressure Mode ( BiPAP ) and Airway Pressure Release Ventilation Mode ( APRV ) ? A Randomized Controlled Study.
Background and Rationale :
Mechanical ventilation is an essential component of the care of patients with respiratory
failure.Biphasic positive Airway Pressure (BiPAP) and Airway Pressure release ventilation
(APRV) are relatively new modes of mechanical ventilation which can be used in treatment of
patients with impaired oxygenation.The effect of using BiPAP and APRV modes on reducing the
physiological dead space had not been previously investigated. The investigators hypothesize
that using APRV mode will decrease physiological dead space more than BiPAP mode in the
mechanically ventilated critically ill patients.
Objectives :
To assess the physiological dead space with each mode. To assess lung mechanics during the
use of the two modes. To assess the effectiveness of ventilation during the use of the two
modes.
Study population & Sample size :
Sixty adult patients more than 18 years old who are mechanically ventilated patients with P/F
ratio less than 300. This sample size was calculated based on the assumption that APRV will
decrease dead space by 20% with alpha error 0.05 and power 80%. The mean and Standard
deviation of the volume of the dead space assessed in a previous study using BIPAP was 40
Study Design :
A randomized controlled non-blinded study with cross-over design. In the Trauma and surgical
ICU at 185-Hospital (Kasr Alainy Hospitals).
Methods :
All mechanically ventilated patients in Trauma and surgical ICU at 185-Hospital (Kasr Alainy
Hospitals) will start on pressure controlled ventilation mode (PCV) with inspiratory pressure
achieving tidal volume 6-8 ml/kg for 2 hours then they will be randomized into one of the two
study groups the BIPAP group or the APRV group .
Possible Risk (s) to study population :
By adjusting the ventilator parameters properly and continuous monitoring of the patients in
the study, there will be no risk facing the patients.
Outcome parameter (s):
Primary outcome: Physiological dead space will be measured in the two groups after 30
minutes.
Secondary outcomes
- Physiological dead space after 3 hours.
- PO2/FiO2 ratio.
- Peak airway and Mean airway pressures.
- PCO2 and PH.
- Dynamic compliance.
Status | Recruiting |
Enrollment | 60 |
Est. completion date | September 2017 |
Est. primary completion date | September 2017 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Adults above 18 years old. - Patients who are recently mechanically ventilated ( within 48 hours ). - Patients with P/F ratio less than 300. Exclusion Criteria: - patients with COPD or pneumothorax. - Patients with acute lung injury. - patients with Emphysema and Emphysematous bullae . - patients with broncho-pleural fistula. - patients with severe hemodynamic instability (on IV Noradrenaline > 0.8 mic/kg/min). - patients with cardiomyopathy , and those with stenotic valvular diseases. - Patients with increased intracerebral pressure. |
Country | Name | City | State |
---|---|---|---|
Egypt | Department of Anesthesia , intensive care and pain management -faculty of medicine Cairo Uni.- kasr Alainy Hospitals. | Cairo |
Lead Sponsor | Collaborator |
---|---|
Kasr El Aini Hospital |
Egypt,
Anderson CT, Breen PH. Carbon dioxide kinetics and capnography during critical care. Crit Care. 2000;4(4):207-15. Epub 2000 Jul 12. Review. — View Citation
Baum M, Benzer H, Putensen C, Koller W, Putz G. [Biphasic positive airway pressure (BIPAP)--a new form of augmented ventilation]. Anaesthesist. 1989 Sep;38(9):452-8. German. — View Citation
Haitsma JJ, Lachmann RA, Lachmann B. Lung protective ventilation in ARDS: role of mediators, PEEP and surfactant. Monaldi Arch Chest Dis. 2003 Apr-Jun;59(2):108-18. Review. — View Citation
Hörmann C, Baum M, Putensen C, Mutz NJ, Benzer H. Biphasic positive airway pressure (BIPAP)--a new mode of ventilatory support. Eur J Anaesthesiol. 1994 Jan;11(1):37-42. Review. — View Citation
Verscheure S, Massion PB, Verschuren F, Damas P, Magder S. Volumetric capnography: lessons from the past and current clinical applications. Crit Care. 2016 Jun 23;20(1):184. doi: 10.1186/s13054-016-1377-3. Review. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Physiological dead space | percentage of vd/vt ( dead space volume/ Tidal volume ) which is measured by volumetric capnography included in the metabolic module on General Electric ventilator (Engstrom Carestation, GE Health care, USA). | after 30 min. on each mode ( APRV and BiPAP ) | |
Secondary | Physiological dead space. | percentage of vd/vt ( dead space volume/ Tidal volume ) which is measured by volumetric capnography included in the metabolic module on General Electric ventilator (Engstrom Carestation, GE Health care, USA). | after 3 hours on each mode ( APRV and BiPAP ). | |
Secondary | PO2/FiO2 ratio | PO2 from ABG / FiO2 set on the ventilator | after 30 min. and 3 hours on each mode ( APRV and BiPAP ). | |
Secondary | Peak airway pressure | measured by the ventilator in cmH2O. | after 30 min. and 3 hours on each mode ( APRV and BiPAP ). | |
Secondary | Mean airway pressure | measured by the ventilator in cmH2O. | after 30 min. and 3 hours on each mode ( APRV and BiPAP ). | |
Secondary | Dynamic compliance | measured by the ventilator ml/cmH2O | after 30 min. and 3 hours on each mode ( APRV and BiPAP ). | |
Secondary | PCO2 | from ABG | after 30 min. and 3 hours on each mode ( APRV and BiPAP ). | |
Secondary | pH | from ABG | after 30 min. and 3 hours on each mode ( APRV and BiPAP ). |
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