Sedation may have many drawbacks in ICU patients: cardiovascular, neurologic, muscular. Light sedation and Pressure Support ventilation is feasible in ARDS patients. However spontaneous breathing can lead to high transpulmonary pressure. The goal of the study is to measure transpulmonary pressure before sedation decrease and after stabilization. The main endpoint is transpulmonary pressure less than 24 cmH2O.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
tapering sedation doses (propofol) switch from assisted ventilation to pressure support ventilation
transpulmonary pressure at early stabilization of patient
transpulmonary pressure (Paw - Peso \< 24 cmH2O)
Time frame: when patient is conscious and stable (no modification of ventilator settings) generally within 2 hours
oxygenation modification
PaO2/FiO2
Time frame: stabilization of ventilator settings; 1hour after stabilization of ventilator settings
arterial pressure modification
Mean arterial pressure
Time frame: stabilization of ventilator settings; 1hour after stabilization of ventilator settings
Heart rate modification
heart rate
Time frame: stabilization of ventilator settings;1hour after stabilization of ventilator settings
vasopressor dose modification
vasopressor dose in norepinephrine equivalent
Time frame: stabilization of ventilator settings ; 1hour after stabilization of ventilator settings
acquired neuromyopathy
MRC \<48/60
Time frame: ICU discharge, an average 16 days
muscular volume decrease
quadriceps volume assessed by echography
Time frame: at 24 hours; at day of extubation; ICU discharge, an average 16 days
ventilator free days
ventilator free days until day 28
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: during the first 28 days
delirium in ICU
CAM-ICU is a valid and reliable delirium assessment tool recommended by the Society of Critical Care Medicine (SCCM) in its 2013 Pain, Agitation and Delirium (PAD) guidelines. the presence of delirium is confirmed in the presence of criteria 1, 2 and 3 or 4.
Time frame: ICU discharge, an average 16 days
change of the functional respiratory parameters from baseline at 6 months
vital capacity, total pulmonary capacity,
Time frame: at 6 months
PTSD
post traumatic stress disorder impact of event scale \> 33 tems are rated on a 5-point scale ranging from 0 ("not at all") to 4 ("extremely") and the total score (ranging from 0 to 88)
Time frame: at 6 months
number of auto extubation
Time frame: whatever until ICU discharge, an average 16 days