Ventilator Settings and Comfort
| Status: | Completed |
|---|---|
| Conditions: | Chronic Obstructive Pulmonary Disease, Obesity Weight Loss, Pulmonary |
| Therapuetic Areas: | Endocrinology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/2/2016 |
| Start Date: | March 2010 |
| End Date: | December 2011 |
What Ventilator Settings Are Most Comfortable for Patients With COPD or Obesity.
No studies have been done to examine whether patients with obstructive lung disease and
obesity are more comfortable on some ventilator settings than on others. The purpose of the
current study is to examine this question systematically.
obesity are more comfortable on some ventilator settings than on others. The purpose of the
current study is to examine this question systematically.
Methods: Demographic and physiologic data will be recorded. Investigators will begin
measurements more than 60 minutes after last dose of sedative and measurements to occur when
no major interventions are planned or medications are scheduled. Then patients will undergo
the following ventilator settings (all of which are within ranges ordinarily employed) in
random order for 3 minutes of each setting (pressures measured midway i.e. 1.5 minutes - at
each interval to ensure safety; stopped if static airway pressure>30 cmH2O):
1. Assist control
1. Tidal volumes of 6 ml/kg, 8 ml/kg and 10 ml/kg
2. Flow regimes: constant (CF) and decelerating (dec) at 40, 60 and 80 L/min;
2. Pressure support (PS) 0, 10 and 20 cmH2O with PEEP=5 cmH2O
Patients will be randomized to receive the following in either forward or reverse order:
CF60L/min in 6 then 8 then 10 ml/kg; then at 8 ml/kg CF40, Dec40, Dec60, CF60, CF80, Dec80;
then PS=0, 10, 20 cmH2O.
In the last 30 second of each setting, patients will be asked to indicate their level of
comfort (1-10 in increasing comfort) using a visual analog Borg Score (when they can
see/write) or to indicate on their fingers when they cannot write.
measurements more than 60 minutes after last dose of sedative and measurements to occur when
no major interventions are planned or medications are scheduled. Then patients will undergo
the following ventilator settings (all of which are within ranges ordinarily employed) in
random order for 3 minutes of each setting (pressures measured midway i.e. 1.5 minutes - at
each interval to ensure safety; stopped if static airway pressure>30 cmH2O):
1. Assist control
1. Tidal volumes of 6 ml/kg, 8 ml/kg and 10 ml/kg
2. Flow regimes: constant (CF) and decelerating (dec) at 40, 60 and 80 L/min;
2. Pressure support (PS) 0, 10 and 20 cmH2O with PEEP=5 cmH2O
Patients will be randomized to receive the following in either forward or reverse order:
CF60L/min in 6 then 8 then 10 ml/kg; then at 8 ml/kg CF40, Dec40, Dec60, CF60, CF80, Dec80;
then PS=0, 10, 20 cmH2O.
In the last 30 second of each setting, patients will be asked to indicate their level of
comfort (1-10 in increasing comfort) using a visual analog Borg Score (when they can
see/write) or to indicate on their fingers when they cannot write.
Inclusion Criteria:
- Adult patients (>18 y) admitted to the MICU of Bridgeport Hospital on mechanical
ventilation for:
- Exacerbation of COPD (smoking history>20 pkyrs AND chest radiographic or
function abnormalities supportive of the diagnosis); OR
- Body mass index>40 kg/m2 and acute on chronic hypercapnic respiratory failure.
- Patients must be awake, not have received narcotics for more than 2 hours and possess
capacity to consent themselves.
- Patients must have recovered sufficiently from their acute illness to be candidates
for weaning per hospital protocol i.e. not in shock, no pressors and PaO2:FiO2>120.
Exclusion Criteria:
- Patients extubated for comfort care only.
- Patients with successful weaning trial that otherwise clinically requires extubation.
- Patients with unresolved pneumonia, unresolved congestive heart failure,
neuromuscular disease or kyphoscoliosis-related respiratory failure will also be
excluded.
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