Comparison of Different Methods to Calculate Pendelluft by Electrical Impedance Tomography in Mechanically Ventilated Patients

Last updated: July 2, 2024
Sponsor: University of Sao Paulo General Hospital
Overall Status: Active - Recruiting

Phase

N/A

Condition

Respiratory Failure

Lung Injury

Treatment

Pressure Support Variation and Calculation of Respiratory Mechanics

Clinical Study ID

NCT06494215
79317924.0.0000.0068
  • Ages > 18
  • All Genders

Study Summary

The Pendelluft phenomenon is an important cause of lung damage in spontaneously breathing mechanically ventilated patients since it considerably increases the stress on the lung parenchyma in the dependent areas. It can result in a local driving pressure up to three times higher than the global driving pressure. The measurement of Pendelluft is still uncertain in the literature, and although various methods have been proposed, not all have the same meaning in terms of pulmonary overstress and overstrain. This study proposes a comparative analysis of different ways to calculate and estimate the stress imposed on the lung parenchyma by Pendelluft in terms of regional volume and local driving pressure through electrical impedance tomography.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patients under invasive mechanical ventilation intubated due to respiratory failurein pressure support mode (weaning phase)

Exclusion

Exclusion Criteria:

  • Age less than 18 years; sedation or neuromuscular blockade; absence of respiratoryeffort; contraindications to esophageal balloon cathether positioning or electricalimpedance tomography belt positioning; presence of pneumothorax or active air leaks;hemodynamic instability; absence of informed consent.

Study Design

Total Participants: 15
Treatment Group(s): 1
Primary Treatment: Pressure Support Variation and Calculation of Respiratory Mechanics
Phase:
Study Start date:
June 11, 2024
Estimated Completion Date:
June 11, 2025

Study Description

Respiratory mechanics and regional ventilation will be monitored by electrical impedance tomography (Enlight 1800 and 2100, Timpel). Esophageal and gastric pressures will be obtained by placing an esophageal/gastric balloon cathether (Nutrivent ®), validation concerning position will be done through modified Baydur maneuver (delta esophageal/delta airway pressure = 0.8-1.2). The hardware Pneumodrive will be used to inflate the balloon and store the airway, gastric and esophageal pressures.

Initially the patients will be monitored with EIT for aproximately 30 minutes after pletismography stabilization. Then, an arterial blood-gas sample shall be collected for analysis. Next, three expiratory and three inspiratory pauses of at least two seconds will be realized with intervals of eight respiratory cycles between them, allowing plateau pressure to be recorded and global and regional driving pressure to be estimated. All this data will be stored for later analysis. The same procedures and measurements shall be made sequentially with a 50% higher pressure support and with a 50% lower pressure support.

Connect with a study center

  • Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP

    São Paulo, 05403-900
    Brazil

    Active - Recruiting

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