RecruitingNot ApplicableNCT05642832

Feasibility of Reducing Respiratory Drive Using the Through-flow System

Feasibility of Reducing Respiratory Drive in Patients with Acute Hypoxemic Respiratory Failure Using the Through-flow System

Sponsor

University Health Network, Toronto

Enrollment

15 participants

Start Date

Jan 1, 2024

Study Type

INTERVENTIONAL

Conditions

Lung Injury Respiratory Insufficiency Diaphragm Injury

Summary

Mechanical ventilation can lead to diaphragm and lung injury. During mechanical ventilation, the diaphragm could be completely rested or it could be overworked, either of which may cause diaphragm injury. Mechanical stress and strain applied by mechanical ventilation or by the patient's own respiratory muscles can also cause injury to the lungs. Diaphragm and lung injury are associated with increased morbidity and mortality. Throughflow is a novel system that can reduce dead space without the need to increase the tidal ventilation, reducing the ventilatory demands and respiratory drive.

Eligibility

Min Age: 18 Years

Inclusion Criteria3

PaO2/FiO2 less than or equal to 300 at time of screening
Oral endotracheal intubation with ETT 7.5 or 8.0 and on invasive mechanical ventilation
Bilateral airspace opacities on chest radiograph or chest CT scan

Exclusion Criteria4

Contraindication to esophageal catheterization (upper gastrointestinal tract surgery within preceding 6 weeks, bleeding esophageal/gastric varices)
Intubation for traumatic brain injury or stroke
Intracranial hypertension (suspected or diagnosed by medical team)
Anticipated liberation from mechanical ventilation within 24 hours

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Interventions

DEVICEThroughflow titration phase

Ventilation will be applied in the TF mode with TF set to 0 LPM for 10 minutes. Patients will receive assist through the NAVA line of the tri-piece (NAVA set to similar settings as Servo period, \~60-80 LPM flow). Ventilation with Throughflow will be started at a TF flow of 5 LPM, and the NAVA flow will be reduced by 5 LPM. After 10 minutes measurements will be collected. If Edi is greater than or equal to 4 µV, TF flow will be increased to 10 LPM and NAVA flow will be adjusted to keep total flow constant. Measurements will be collected again after 10 minutes. TF flow will be increased in steps of 5 LPM and measurements collected every 10 minutes until Edi is below 3 µV or TF flow reaches the total flow observed during the NAVA period. After either the Edi target has been met or TF flow has reached the total flow, ventilation with TF will be reduced in steps of 5 LPM every 10 minutes (the reverse of the above), while NAVA flow is accordingly adjusted to keep total flow constant.