Flow controlled ventilation (FCV) is a fairly new mode of mechanical ventilation, consisting of a constant inspiratory and expiratory flow. Inspiration is thus comparable to volume controlled ventilation (VCV). The actively controlled, constant flow during expiration is unique. FCV is known to minimize dissipated energy to the lung \[ref\] and is therefore supposed to aid in lung protective ventilation. The VICAR study is designed as a prospective single cohort crossover trial. The intervention consists of a sequence of respiratory modes: baseline pressure controlled ventilation (PCV) during 5 minutes, followed by 30 minutes of FCV with an evone respirator (Ventinova Medical B.V., Eindhoven, The Netherlands) and eventually 30 minutes of VCV. Every participant will receive the intervention. Respiratory rate (RR), positive end-expiratory pressure (PEEP) and inspiratory fraction of oxygen (FiO2) will be held constant. According to the manufacturers guidelines, an I:E ratio of 1:1 will be pursued during FCV. During FCV, the respirator will be set with the same PIP as during baseline PCV. For VCV, the same tidal volume as during baseline PCV will be set.
Study Type
OBSERVATIONAL
Enrollment
11
Arterial blood gasses will be drawn during baseline PCV, and every 15 minutes during FCV and VCV respectively. pO2 (mmHg), pCO2 (mmHg) and pH will be recorded.
Hemodynamic parameters (invasive arterial blood pressure (mmHg) and heart rate (beats per minute)) will be recorded every 5 minutes.
Tidal volume (ml), respiratory rate (breaths per minute), minute volume (l/min), dynamic compliance (ml/cmH2O), resistance (cmH2O/l/min), plateau pressure (cmH2O), mean airway pressure (cmH2O), positive end-expiratory pressure (cmH2O), peak inspiratory pressure (cmH2O) and fraction of inspired oxygen will be recorded every 5 minutes.
Antwerp University Hospital
Edegem, Antwerp, Belgium
Arterial oxygen tension, PaO2 (mmHg)
Arterial partial oxygen tension as measured on an arterial blood gas sample.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
P/F ratio or Horowitz index (mmHg)
Ratio of the arterial oxygen tension PaO2 (mmHg) divided by the inspiratory fraction of oxygen FiO2.
Time frame: Post hoc calculation
SpO2 (%)
Oxygen saturation as measured by pulse oxymetry.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
FiO2
Fraction of inspired oxygen as measured by the respirator.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
PEEP (cmH2O)
Positive end-expiratory pressure as measured by the respirator.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
Pmean
Mean airway pressure (cmH2O) as measured by the respirator.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
PaCO2
Arterial partial tension of carbon dioxide (mmHg) as measured on an arterial blood gas sample.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
MV
Minute volume (l/min) as measured by the respirator.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
TV
Tidal volume (ml) as measured by the respirator.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
RR
Respiratory rate (breaths per minute) as measured by the respirator.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
Pplat
Plateau airway pressure (cmH2O) as measured by the respirator
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
PIP
Peak inspiratory airway pressure (cmH2O) as measured by the respirator.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
ABPsys
Systolic arterial blood pressure (mmHg) as measured by a pressure transducer on an arterial catheter.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
ABPmean
Mean arterial blood pressure (mmHg) as measured by a pressure transducer on an arterial catheter.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
ABPdia
Diastolic arterial blood pressure (mmHg) as measured by a pressure transducer on an arterial catheter.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
HR
Heart rate (beats per minute) as measured on a 5-lead continuous electrocardiogram.
Time frame: Approximately 1 hour (5 min. PCV + 30min. FCV + 30 min. VCV)
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