Respiratory Insufficiency Clinical Trial
Official title:
Impact of the Type of Pressure Controlled Mode on Lung Protection in Mechanically Ventilated Patients With Spontaneous Breathing
Mechanical ventilation (MV) is a cornerstone of management of acute respiratory failure, but
MV per se can provoke ventilator-induced lung injury (VILI), especially in acute respiratory
distress syndrome (ARDS). Lung protective ventilation strategy has been proved to prevent
VILI by using low tidal volume of 6-8 ml/kg of ideal body weight and limiting plateau
pressure to less than 30 cmH2O. However, heavy sedation or even paralysis are frequently
used to ensure the protective ventilation strategy, both of which are associated with
respiratory muscles weakness. Maintaining of spontaneous breathing may decrease the need of
sedative drug and improve gas exchange by promoting lung recruitment.
Pressure-targeted mode is the most frequent way of delivering after 48 hours of initiating
MV. Three types of pressure-controlled mode are available in intubated patients: Biphasic
Intermittent Positive Airway Pressure (BIPAP), Airway Pressure Release Ventilation (APRV),
and Pressure-Assist Controlled Ventilation (also called BIPAPassist). They are based on
pressure regulation but have the difference in terms of synchronization between the patient
and the ventilator. The different working principle of these modes may result in different
breathing pattern and consequently different in tidal volume and transpulmonary pressure,
which may be potentially harmful. The investigators bench study with a lung model
demonstrated higher tidal volume and transpulmonary pressure with the BIPAPassist over APRV
despite similar pressure settings and patient's simulated effort. However, the impact of
each mode on the delivered tidal volume and the transpulmonary pressure in spontaneously
breathing mechanically ventilated patients is currently unknown. Their hypothesis is that
when the investigators compare the three pressure-controlled modes, the asynchronous mode
(APRV) will result in more protective ventilation strategy over the two other modes (BIPAP
and BIPAPassist).
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