Prediction of Response to Recruitment Maneuvers in Patients With Acute Respiratory Failure

Launched by UNIVERSITÀ DEGLI STUDI DI FERRARA · Sep 15, 2016

Keywords

ClinConnect Summary

The investigators will monitor lung ventilation by EIT during the whole protocol and perform P-V curves and arterial blood gas analysis at every step of the protocol.

Participants will be sedated and paralyzed, ventilated in volume-controlled with protective ventilation (tidal volume=6-8 mL/Kg of predicted body weight and respiratory rate set to obtain normal pH) then the protocol will follow 5 steps each lasting 20 minutes to obtain clinical stability:

1. PEEP 5 centimeter of water (cmH2O)
2. PEEP 10 cmH2O
3. Recruitment maneuver followed by PEEP 15 cmH2O
4. PEEP 10 cmH2O
5. PEEP 5 cmH2O

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients with acute hypoxemic respiratory failure defined by recent known clinical insult or worsening of respiratory symptoms and arterial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) ≤300 mmHg
• • Patient on invasive mechanical ventilation
• • Age ≥18 years
• • Written informed consent
• Exclusion Criteria:
• • Pregnancy
• • Unstable hemodynamic condition requiring blood transfusion or adjustment of inotropics more often than every hour
• • FiO2 ≥80% or clinical suspicion of pulmonary embolism
• • Pneumothorax
• • Chronic obstructive pulmonary disease (COPD) with clinical symptoms of lung emphysema as evidenced by chest radiography or computed tomography or autoPEEP \> 5 cmH2O
• • Intracranial hypertension
• • Impossibility to correctly position the EIT belt (e.g., dressings, chest drainage, etc.)
• • Contraindications to EIT (e.g., implantable cardiac defibrillator, pacemaker, instable spinal lesions)