Comparison Between Different Ventilator Hyperinflation Maneuvers

B

Brazilian Institute of Higher Education of Censa

Status

Completed

Conditions

Ventilator Associated Pneumonia
Infections, Respiratory

Treatments

Other: PSV
Other: VCV20
Other: PCV
Other: VCV40
Other: PCV+Tins

Study type

Interventional

Funder types

Other

Identifiers

NCT03631342
VHI Modality

Details and patient eligibility

About

The hyperinflation ventilator was performed in different modalities and ventilatory adjustments, with total pressure of 40cmH2O. The inspiratory volume, inspiratory time, mean airway pressure, inspiratory and expiratory flow, and bias flow were evaluated.

Full description

PURPOSE: To compare different ways of applying ventilator hyperinflation. METHODS: A randomized crossover clinical trial was performed with 30 patients (66.5 ± 17.3 years) with hypersecretion. The ventilator hyperinflation was performed in five ventilatory modalities for five minutes, with an interval of 2 hours, the order being determined by randomization: controlled ventilation at volume (VCV) with constant flow of 20 (VCV20) Lpm and 40 Lpm (VCV40), controlled ventilation pressure ventilation (PCV), controlled pressure ventilation associated with inspiratory time adjustment (PCV + Tins) and support pressure ventilation (PSV). In VCV mode, the volume was increased every 50mL, until reaching a maximum pressure of 40cmH2O. In the pressure controlled modes, the inspiratory pressure was increased every 5 cmH2O until the total pressure reached 40 cmH2O. The inspiratory time was adjusted so that the inspiratory flow reached the baseline. The following variables were evaluated: tidal volume, inspiratory time (Tins), mean airway pressure (Pmean), peak inspiratory flow (PIFR) and expiratory flow (PEFR), PIFR / PEFR and Bias Flow (PEFR-PIFR).

Enrollment

30 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Pulmonary infection
  • Mechanically ventilated for more than 96 hours through pressure-assisted ventilation (PSV) or pressure-controlled ventilation (PCV)
  • Static compliance between 30 and 70 mL/cmH2O
  • PEEP between 5 and 8 cmH2O.

Exclusion criteria

  • Hemodynamic instability
  • Non-drained pleural effusion or pneumothorax
  • Intracranial hypertension
  • Bronchospasm
  • Adult respiratory distress syndrome (ARDS)
  • Decompensated congestive heart failure

Trial design

Primary purpose

Other

Allocation

Randomized

Interventional model

Crossover Assignment

Masking

None (Open label)

30 participants in 5 patient groups

VCV20
Experimental group
Description:
Volume-controlled ventilation mode under constant flow of 20 Lpm. The inspired volume was progressively increased until the maximum pressure reached 40cmH2O.
Treatment:
Other: VCV20
VCV40
Experimental group
Description:
Volume controlled ventilation mode under constant flow of 40 Lpm. The inspired volume was progressively increased until the maximum pressure reached 40cmH2O.
Treatment:
Other: VCV40
PCV
Experimental group
Description:
Pressure controlled ventilation mode, inspiratory time of 1 second. The inspiratory pressure was increased every 5 cmH2O, until reaching the maximum pressure of 40 cmH2O.
Treatment:
Other: PCV
PCV+Tins
Experimental group
Description:
Pressure controlled ventilation mode and inspiratory pressure was increased every 5cmH2O, until the maximum pressure of 40 cmH2O was reached. The inspiratory time was gradually increased until the inspiratory flow reached the baseline. Concomitantly, the respiratory rate was decreased to allow the expiratory flow also to reach the baseline, to avoid self-PEEP.
Treatment:
Other: PCV+Tins
PSV
Experimental group
Description:
Pressure support ventilation mode, with progressive increases of 5 cmH2O at inspiratory pressure, until reaching Pmax of 40 cmH2O. The expiratory sensitivity was adjusted by 25% for all patients.
Treatment:
Other: PSV

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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