Comparison of the Hemodynamic Safety of Two Common Alveolar Recruitment Manoeuvres With Regard to Cardiac Output in a Surgical Intensive Care Unit (RHERA1)

Centre Hospitalier Universitaire, Amiens

Status: Completed

Conditions: Positive-Pressure Respiration

Treatments: Device: echocardiography; Device: Arterial oximetry

Study type: Observational

Funder types: Other

Identifiers

NCT02805036

PI2015_843_0002

Details and patient eligibility

About

Protective ventilation - combining a low tidal volume (between 6 and 8 ml/kg) and alveolar recruitment (AR) manoeuvres repeated every 30 minutes - is currently the standard of care for decreasing morbidity associated with mechanical ventilation.

In contrast, there is no consensus on the type of recruitment manoeuvre, which varies from one centre to another and from one study to another.

The investigators intend to compare two currently used AR techniques with regard to their ventilatory efficacy and hemodynamic safety:

• An end-tidal plateau at 30 cmH20 for 30 seconds.
• An end-tidal plateau at 10 cmH20 above the patient's plateau pressure for 30 seconds, without exceeding 30 cmH20.

Enrollment: 30 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All sedated, intubated, mechanically ventilated adult patients (over-18) admitted to the surgical intensive care unit and equipped with a central venous catheter and an arterial catheter.
• Good echogenicity
• Social security coverage

Exclusion criteria

• Pregnancy
• Cardiac arrhythmia
• Poor echogenicity
• Legal guardianship or incarceration
• Systolic blood pressure ≤90 mmHg
• Respiratory distress
• Patients admitted on an emergency basis (first 24 hours), i.e. not for elective surgery

Trial design

30 participants in 2 patient groups

30 cmH20 for 30 seconds

Description:

plateau pressure is hold on at 30 cmH20 pour 30 seconds. The cardiac output and the lung aeration is assessed by ultrasound measures at 3 times: before, at the end of the recruitment and 30 minutes later. echocardiography - arterial oximetry

Treatment:

Device: Arterial oximetry

Device: echocardiography

10 cmH20 above

Description:

plateau pressure is hold on at 10 cmH20 above. The cardiac output and the lung aeration is assessed by ultrasound measures at 3 times: before, at the end of the recruitment and 30 minutes later. echocardiography - arterial oximetry

Treatment:

Device: Arterial oximetry

Device: echocardiography