Capnodynamic Monitoring of Cardiorespiratory Function in Critically Ill Patients

  • STATUS
    Recruiting
  • End date
    Jul 1, 2023
  • participants needed
    100
  • sponsor
    South West Sydney Local Health District
Updated on 27 October 2021
pneumonia
mechanical ventilation
shock
septic shock
acute respiratory distress syndrome

Summary

Capnodynamic monitoring has the potential to offer continuous and non-invasive measurements of heart and lung function in patients requiring ventilation in an intensive care setting. Since mechanical ventilation with full patient synchronization is commonly used in ICU, capnodynamic monitoring can be immediately embedded in clinical care and compared to current methods of monitoring cardiac output, lung volumes and oxygen delivery. This observational study will explore capnodynamic monitoring in mechanically ventilated patients with a range of cardiorespiratory compromise.

Description

This study aims to:

  1. compare the estimation of cardiac output (CO) using the capnodynamic method (COEPBF) with contemporary reference methods;
  2. compare the estimation of mixed venous oxygen saturation (SmvO2) with invasively obtained blood gas analyses;
  3. generate observational data on end-expiratory lung volume (EELV) when ventilator settings, and in particular PEEP, are changed;
  4. combine 1-3 to provide a physiological construct of cardiorespiratory function

Details
Condition Postoperative Respiratory Distress, Sepsis and Septicemia, sepsis, Septicemia, acute respiratory infections, Acute Respiratory Infection, systemic infection, systemic infections, sepsis syndrome
Treatment Capnodynamic monitoring
Clinical Study IdentifierNCT05082168
SponsorSouth West Sydney Local Health District
Last Modified on27 October 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Respiratory tract infection
confirmed or highly suspected viral or bacterial pneumonia
meeting ARF or ARDS criteria as outlines in the most recent Berlin ARDS consensus statement
age 18 years or above
arterial and central venous catheters have been inserted or will be inserted as part of routine clinical management
mechanical ventilation via an endotracheal tube is expected to continue for the day beyond day of admission
adequate transthoracic echocardiographic winds are available to measure the velocity time integral in the left ventricular outflow tract
analgosedation is administered as part of routine management of residual neuromuscular blockaded initiated outside ICU OR the administration of analgosedation and/or neuromuscular blockers at doses that achieve full patient-ventilator synchrony are considered part of routine clinical management
Sepsis
admitted to ICU with a provisional or established diagnosis of septic shock as defined by the Sepsis-3 criteria
age 18 years or above
arterial and central venous catheters have been inserted or will be inserted as part of routine clinical management
mechanical ventilation via an endotracheal tube is expected to continue for at least another two hours
adequate transthoracic echocardiographic winds are available to measure the velocity time integral in the left ventricular outflow tract
analgosedation is administered as part of routine management of residual neuromuscular blockaded initiated outside ICU OR the administration of analgosedation and/or neuromuscular blockers at doses that achieve full patient-ventilator synchrony are considered part of routine clinical management
the administration of a fluid bolus (250 ml or 500 ml) is indicated as judged by the medical officer supervising routine management
Cardiac surgery
admitted to ICU following cardiac surgery using cardiopulmonary bypass
age 18 years and above
arterial, central venous and pulmonary arterial catheters have been inserted or will be inserted as part of routine clinical management
mechanical ventilation via an endotracheal tube is expected to continue for at least another two hours
analgosedation is administered as part of routine management of residual neuromuscular blockade initiated intraoperatively OR the administration of analgosedation and/or neuromuscular blockers at doses that achieve full patient-ventilator synchrony are considered part of routine clinical management
the administration of a fluid bolus (250 ml or 500 ml) is indicated as judged by the medical officer supervising routine postoperative management

Exclusion Criteria

In all cohorts
age under 18 years
known pregnancy
arterial and central venous catheters are not indicated as part of routine care
known severe valvulopathy
ongoing or imminent need for mechanical circulatory support
severe haemodynamic instability with imminent transfer for intervention(s) outside ICU
patient is not for full active management in ICU
patient is not expected to live beyond the day of admission
patient is re-admitted to ICU within the same index hospital admission
it is not possible to achieve full patient-ventilator synchrony
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