Screening Expiratory Flow Limitation by Flow-time Curve

Unity Health Toronto45 enrolled

Overview

Expiratory flow limitation (EFL) is defined as a dynamic condition that expiratory flow cannot be further increased with higher expiratory driving pressure. Under mechanical ventilation, it can cause intrinsic positive end-expiratory pressure (PEEP) and dynamic hyperinflation, and be associated with worse clinical outcome. The detection of EFL however needs special maneuvers and offline analysis of flow-volume curves, which are infeasible in routine practice and cannot be used during real-time monitoring. The investigators propose a new and simple approach using flow derived parameters to detect EFL in real time without needing any intervention.

Study Type

OBSERVATIONAL

Enrollment

Conditions

ARDS, Human

Eligibility

Sex: ALLMin age: 18 YearsMax age: 99 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age ≥18 years, intubated or tracheostomized 2. Receiving invasive mechanical ventilation in assist/control mode with PEEP ≥ 5 cmH2O 3. Receiving continuous intravenous sedation 4. Displaying a monotonous regular breathing pattern with no obvious asynchrony Exclusion Criteria: 1. Severe hypoxemia in baseline clinical ventilator settings (SpO2 \< 90%) 2. Hemodynamic instability (mABP \<60 mmHg, systolic arterial pressure \>180 mmHg, heart rate \<40/min or \>150/min)

Locations (1)

St. Michael's Hospital

Toronto, Ontario, Canada

Outcomes

Primary Outcomes

Outcome (Presence / absence of EFL) will be determined by off-line analysis of recorded flow-volume loops during PEEP reduction.

Time frame: 2 years

Secondary Outcomes

Percentage of intrinsic PEEP caused by the EFL.

Time frame: 2 years

Data from ClinicalTrials.gov

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