Respiratory Failure Clinical Trial
Official title:
Selecting the Best Ventilator Hyperinflation Settings Based on Physiologic Markers: Randomized Controlled Study
Ventilator hyperinflation (VHI) has been shown to be effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated patients; however, there are no recommendations on the best ventilator settings to perform the technique. Thus, the aim of this study was to compare six modes of VHI, concerning physiological markers of efficacy and safety criteria, in order to support the optimal VHI settings selection for mechanically ventilated patients. In a randomized, controlled and crossover study, 30 mechanically ventilated patients underwent 6 modes of ventilator hyperinflation. The maximum expansion (tidal volume), expiratory flow bias criteria (inspiratory and expiratory flow patterns), overdistension (alveolar pressure), asynchronies and hemodynamic variables (mean arterial pressure and heart rate) were assessed during the interventions.
Background: Ventilator Hyperinflation (VHI) has been shown to be effective in improving
respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated
patients; however, there are no recommendations on the best ventilator settings to perform
the technique. Thus, the aim of this study was to compare six modes of VHI, concerning
physiological markers of efficacy and safety criteria, in order to support the optimal VHI
settings selection for mechanically ventilated patients.
Methods: In a crossover study, every included mechanically ventilated patient underwent six
modes of VHI in a randomized order: Volume Control Continuous Mandatory Ventilation (VC-CMV)
with inspiratory flow = 20Lpm (VC-CMV20), VC-CMV with inspiratory flow = 50Lpm (VC-CMV50),
Pressure Control Continuous Mandatory Ventilation (PC-CMV) with inspiratory time = 1s.
(PC-CMV1), PC-CMV with inspiratory time = 3s. (PC-CMV3), Pressure Support Ventilation (PSV)
with cycling off = 10% of peak inspiratory flow (PSV10), and PSV with cycling off = 25% of
peak inspiratory flow (PSV25). The maximum expansion (tidal volume), expiratory flow bias
criteria (inspiratory and expiratory flow patterns), over-distension (alveolar pressure),
asynchronies and hemodynamic variables (mean arterial pressure and heart rate) were assessed
during the interventions.
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