Protective Manual Hyperinflation in Acute Mechanically Ventilated Trauma Patients

The University of Queensland40 enrolled

Overview

This single-blinded randomized study aims to compare two methods of manual hyperinflation (protective - moderate tidal volumes with positive end expiratory pressure) and non-protective (large tidal volume and no positive end expiratory pressure) in ventilated acute trauma patients, to investigate the effect on inflammatory markers, lung compliance, oxygenation and sputum volume.

Current evidence in mechanical ventilation supports a "protective lung strategy" that is, smaller tidal volumes and prevention of loss of positive end expiratory pressure (PEEP). There is concern that manual hyperinflation (MHI) may conflict with this strategy and cause volutrauma and atelectrauma potentially leading to biotrauma. This single-blinded randomized study aims to compare two methods of manual hyperinflation (protective - moderate tidal volumes with positive end expiratory pressure) and non-protective (large tidal volume and no positive end expiratory pressure) in ventilated acute trauma patients, to investigate the effect on inflammatory markers, lung compliance, oxygenation and sputum volume.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Critically Injured Mechanically Ventilated Trauma Patients

Interventions

Protective manual hyperinflationOTHER

Manual hyperinflation for 10 minutes using a Mapleson C circuit and 100% oxygen with volume set at 8mls/kg and positive end expiratory pressure in the circuit appropriate to baseline levels

Usual method of MHIOTHER

Manual hyperinflation for 10 minutes using a Mapleson C circuit and 100% oxygen with volume set at 12mls/kg and no positive end expiratory pressure in the circuit

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Trauma patients * Day 1 of admission to intensive care * Mechanically ventilated Exclusion Criteria: * Pre-existing lung disease * PEEP \> 12.5cmH20 * Nitric oxide in circuit * Haemodynamically unstable * Undrained pneumothorax * Intracranial pressure \> 25mmHg

Locations (1)

Royal Brisbane & Womens Hospital

Brisbane, Queensland, Australia

Outcomes

Primary Outcomes

Interleukin 6

5 mls of arterial blood will be colected in an EDTA tube, centrifuged and aliquoted within 30 minutes. It will be stored at -80 degrees C and the analysis completed in batches by enzyme linked immunosorbent assay

Time frame: Change between Baseline and 40 minutes and 70 minutes post baseline

Secondary Outcomes

Tumour necrosis factor alpha

Time frame: Change from Baseline to 40 minutes and 70 minutes post baseline

Interleukin 1-beta

Time frame: Change between baseline and 40 minutes and 70 minutes post baseline

Interleukin 8

Time frame: Change between baseline and 40 minutes and 70 minutes post baseline

PaO2/FiO2 Oxygenation ratio

The ratio between the partial pressure of oxygen in arterial blood and the fraction of inspired oxygen which is delivered to the patient.

Time frame: Chnge between baseline and 15 minutes and 40 minutes post baseline

Static lung compliance

Static lung compliance is the change in volume for any given applied pressure. The formula is Compliance = Change in volume/change in pleural pressure. An inspiratory hold will be dialled on the mechanical ventilator and the static lung compliance value will be recorded from the screen.

Data from ClinicalTrials.gov

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