Decreasing Trigger Sensitivity Could Assist PEEP to Further Improve Regional Ventilation Distribution

Decreasing Trigger Sensitivity Could Assist PEEP to Further Improve Regional Aeration and Homogeneity During Pressure Assist Ventilation: A Preliminarily Physiological Study

In mechanically ventilated patients during supine position, alveolar collapse usually distributes in dependent lung region.Decrease of flow trigger sensitivity might improve homogeneous of tidal volume distribution.

Study Overview

• Status: Completed
• Conditions: Mechanical Ventilation
• Intervention / Treatment: Procedure: flow trigger

Detailed Description

In mechanically ventilated patients during supine position, alveolar collapse usually distributes in dependent lung region. High positive end expiratory pressure (PEEP) has been applied to improve the homogeneous distribution of ventilation by increasing the end expiratory lung ventilation (EELV) and alveolar recruitment. However, for patients who increasing PEEP in some extent still existed poor aeration in the dependent region, further elevating PEEP seems to be unreasonable that perhaps lead to overdistension. Decreasing trigger sensitivity might further evoke inspiratory efforts to improve the ventilation for this type of patients.The Electrical impedance tomography (EIT) was applied in monitoring the regional ventilation distribution at the bedside.

• Study Type: Observational
• Enrollment (Actual): 20

Contacts and Locations

Study Locations

• China
  • Beijing
    • Beijing, Beijing, China, 100050
      • Jian-Xin Zhou

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The postoperative patients receiving pressure support ventilation and existing heterogenous ventilation.

Description

Inclusion Criteria:

1. The post operative patients who received pressure support ventilation;
2. After the clinical PEEP was evaluated 5cmH2O, the tidal volume distribution still existed heterogeneity.

Exclusion Criteria:

1. Under 18 years;
2. History of diaphragm dysfunction and surgery;
3. Central respiratory drive dysfunction;
4. history of esophageal, gastric or lung surgery;
5. The contraindication of using EIT (pacemaker, defibrillator, and implantable pumps).

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
the lowest trigger sensitivity; The flow trigger of ventilator was set as the lowest level of sensitivity.	Procedure: flow trigger; The flow trigger will be adjust during the pressure assist ventilation.
the highest trigger sensitivity; The flow trigger of ventilator was set as the highest level of sensitivity.	Procedure: flow trigger; The flow trigger will be adjust during the pressure assist ventilation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The homogeneity of distribution of tidal volume	EIT was used to monitoring the homogeneity of distribution of tidal volume that was divided into two contiguous regions of interest (ROI) equally, the dependent and non-dependent area. The ratio of relative distribution of tidal ventilation of two ROI was calculated.	within 20 minutes after changing flow trigger

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in global and regional EELV	The change of EELV was measured after changing flow trigger based on the baseline level.	within 20 minutes after changing flow trigger

Collaborators and Investigators

• Sponsor: Capital Medical University
• Investigators: Principal Investigator: Jian-Xin Zhou, MD, Beijing Tiantan Hospital

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2017
• Primary Completion (Actual): August 20, 2017
• Study Completion (Actual): February 1, 2018

Study Registration Dates

• First Submitted: August 3, 2017
• First Submitted That Met QC Criteria: August 4, 2017
• First Posted (Actual): August 7, 2017

Study Record Updates

• Last Update Posted (Actual): February 12, 2018
• Last Update Submitted That Met QC Criteria: February 9, 2018
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Hypersensitivity
• Other Study ID Numbers: KY-2017-001

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No