Ventilator Hyperinflation With Increase of Inspiratory Time

Brazilian Institute of Higher Education of Censa

Status: Completed

Conditions: Lung Infection; Mechanical Ventilation

Treatments: Other: Ventilator hyperinflation

Study type: Interventional

Funder types: Other

Identifiers

NCT03630510

VHI + Tins

Details and patient eligibility

About

The investigators hypothesis is that the adjustment of the inspiratory time may optimize the distribution of ventilation and increase tidal volume, producing potential therapeutic effects on the displacement of secretions and respiratory mechanics. The objective of this study was To evaluate the effects of hyperinflation with the ventilator associated with increased inspiratory time on respiratory mechanics.

Full description

A randomized crossover clinical trial was conducted with 38 mechanically ventilated patients with pulmonary infection. The order of hyperinflation or control (without changes in parameters) was randomized. Hyperinflation was performed for 5 minutes in the controlled pressure ventilation mode, with progressive increases of 5cmH2O until reaching a maximum pressure of 35cmH2O, maintaining PEEP. After reaching 35cmH2O, the inspiratory time and respiratory rate were adjusted so that the inspiratory and expiratory flows reached the baseline, respectively. Static compliance (Cest, sr), total resistance (Rsr) and airway resistance (Rva), slow pressure drop (ΔP2) and peak expiratory flow (PEF) were assessed before (PRÉ), immediately after the maneuver (POSSimed) and after aspiration (POSPasp). Two-way ANOVA was used for repeated measurements with Tukey post-test, considering a significant p <0.05.

Enrollment: 38 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients under mechanical ventilation for more than 48h
• Mucus hypersecretion (defined as the need for suctioning < 2-h intervals)

Exclusion criteria

• Severe bronchospasm,
• Positive end expiratory pressure > 10cmH2O,
• PaO2-FiO2 relationship < 150,
• Mean arterial pressure < 60mmHg,
• Pleural effusion or pneumothorax undrained,
• Bronchopleural or tracheoesophageal fistula,
• Decompensated congestive heart failure.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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38 participants in 2 patient groups

mechanical ventilator hyperinflation

Experimental group

Description:

The VHI maneuver with inspiratory time adjustment was performed in the pressure controlled ventilation mode (PCV). The inspiratory pressure was increased gradually every 5 cmH2O until reaching a maximum pressure of 35 cmH2O, according to the tolerance of the patient determined by the absence of cough. PEEP remained unchanged throughout the study. After reaching a maximum pressure of 35 cmH2O (PCV + PEEP level), 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. The maneuver was performed for 5 min, followed by tracheal aspiration.

Treatment:

Other: Ventilator hyperinflation

Control

No Intervention group

Description:

To perform the control (CTRL), the patients were only positioned and aspirated, without alteration in ventilatory parameters.