Prediction of Inspiratory Effort Response to High PEEP in Patients Recovering From ARDS
Sanatorio Anchorena San Martin
30 participants
Aug 1, 2020
OBSERVATIONAL
Conditions
Summary
Spontaneous breathing during the transition from controlled to assisted ventilation in ARDS may be harmful, as high respiratory drive can generate large transpulmonary pressure swings and worsen lung injury. Higher PEEP may mitigate this by reducing inspiratory effort and lung stress, but patient response is variable and difficult to predict. While improved lung compliance appears to mediate the protective effects of PEEP, its bedside assessment is complex. Preclinical data suggest that changes in compliance are inversely reflected by changes in respiratory rate, but this relationship and its clinical utility in ARDS patients remain unclear.
Eligibility
Inclusion Criteria4
- Need of invasive mechanical ventilation
- Patients who had fulfill ARDS criteria based on Berlin definition during any time of invasive mechanical ventilation.
- Patient ventilated in pressure support ventilation.
- Time of invasive ventilation expected to be longer than 24 hs after the day of enrollment.
Exclusion Criteria5
- Neuromuscular diseases (e.g., amyotrophic lateral sclerosis, Duchenne Erb)
- previous diagnosis of chronic obstructed pulmonary disease
- not resolved pneumothorax
- bronchopleural fistula
- suspicion of central respiratory drive alteration (e.g., benzodiazepines intoxication).
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Interventions
Initially, the patients will be ventilated using pressure support ventilation with an inspiratory pressure adjusted to achieve 6 - 8 ml/kg of PBW with a minimal esophageal pressure swing of 5 cmH2O and a PEEP of 5 cmH2O. After 5 minutes, we will collect basic and advanced respiratory monitoring, including esophageal pressure and transpulmonary pressure swings. The same procedure will be carried out with 10 and 15 cmH2O of PEEP. Inspiratory pressure will be kept constant throughout the protocol.
Locations(1)
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NCT04524091