Respiratory Failure Clinical Trial
Official title:
Hemodynamic Repercussions of Ventilator Hyperinflation Using Volume-controlled Ventilation: a Randomized Controlled Trial
Ventilator hyperinflation (VHI) has been shown to be effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated patients; however, the literature is scarce concerning its safety and adverse effects. Thus, the aim of this study is to compare the hemodynamic repercussions of VHI in volume-controlled mode. In a randomized, controlled and crossover design, 24 mechanically ventilated patients will undergo 2 modes of ventilator hyperinflation (with and without an inspiratory pause) and a control intervention. Cardiac output, cardiac index, mean arterial pressure, pulmonary vascular resistance, systolic volume and other hemodynamic variables will be recorded 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, the literature is scarce concerning its safety and adverse effects. Thus,
the aim of this study is to compare the hemodynamic repercussions of VHI in volume-controlled
mode.
Methods: in a randomized, controlled and crossover design, 24 mechanically ventilated
patients will undergo 2 modes of ventilator hyperinflation (with and without an inspiratory
pause of 2 seconds) and a control intervention. For the VHI interventions, the inspiratory
flow will be set at 20 Lpm, and tidal volume will be increased until a peak pressure of
40cmH2O is achieved. During the control intervention, the patients will remain in
volume-control ventilation with an inspiratory flow = 60Lpm and tidal volume = 6mL/IBW. The
interval between interventions (washout) will be of 10 minutes or more, according to the time
needed to recover the cardiac index to baseline values (maximum difference of 10%). Cardiac
output, cardiac index, mean arterial pressure, pulmonary vascular resistance, systolic volume
and other hemodynamic variables will be recorded during the interventions by using impedance
cardiography.
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