Mechanical Power During Pressure Controlled Versus Volume-Controlled Ventilation in Acute Respiratory Failure

N/ANot Yet RecruitingNCT07834970

Assiut University186 enrolled

Overview

This prospective observational cohort study aims to compare mechanical power between pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in critically ill adult patients receiving invasive mechanical ventilation. Mechanical power will be assessed at different time points during the first 24 hours after intubation, with the primary comparison performed at 24 hours. The study will also evaluate the association between mechanical power and clinical outcomes, including ICU mortality, hospital mortality, successful weaning, duration of mechanical ventilation, and length of ICU and hospital stay.

Mechanical ventilation is a life-saving intervention for critically ill patients with acute respiratory failure. However, mechanical ventilation can also contribute to ventilator-induced lung injury when excessive energy is delivered to the respiratory system. Mechanical power, which represents the energy transferred from the ventilator to the respiratory system per unit of time, has emerged as a potentially important parameter for assessing the intensity of mechanical ventilation. The mode of ventilation may influence mechanical power through changes in airway pressure, tidal volume, respiratory rate, and inspiratory flow. Pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) are commonly used modes of invasive mechanical ventilation, but their effects on mechanical power in critically ill patients may differ. Therefore, this prospective observational cohort study aims to compare mechanical power between PCV and VCV in critically ill adult patients receiving invasive mechanical ventilation and to evaluate the relationship between mechanical power and relevant clinical outcomes.

Study Type

OBSERVATIONAL

Enrollment

186

Conditions

Mechanical Power Acute Respiratory Failure

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients aged \>18 years. * Patients with acute respiratory failure who are receiving invasive mechanical ventilation. Exclusion Criteria: * Patients whose condition requires shifting between VCV and PCV after enrollment. * Patients with neurological, neuromuscular, or muscular disorders. * Neurological disorders, e.g., stroke, multiple sclerosis, Parkinsonism, and Guillain-Barré syndrome. * Neuromuscular junction disorders, e.g., myasthenia gravis. * Muscular disorders, e.g., polymyositis and Duchenne muscular dystrophy. * Chest wall abnormalities, e.g., kyphoscoliosis, scoliosis, and pectus excavatum. * Tracheostomized patients. * Patients with raised intra-abdominal pressure (IAP ≥12 mmHg), as estimated by transvesical manometry e.g., massive ascites, bowel obstruction, and postoperative abdominal surgery. * Patients with documented chronic type 2 respiratory failure, characterized by an elevated partial pressure of carbon dioxide (PaCO₂ \>45 mmHg), low partial pressure of oxygen (PaO₂), and chronically elevated bicarbonate (HCO₃-) reflecting renal compensation.

Outcomes

Primary Outcomes

Mechanical power

Mechanical power will be measured and compared between pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) at 24 hours after intubation.

Time frame: 24 hours after intubation

Secondary Outcomes

mechanical power and ICU mortality, hospital mortality, time to death.

Correlation between mechanical power and ICU mortality, hospital mortality, time to death . * ICU mortality documented as binary (yes/no) outcome indicating death occurring exclusively during ICU admission. * Hospital mortality: documented as binary (yes/no) outcome indicating death occurring during hospitalization, regardless of the location of care at time of death. * Time-to-death: documented in days from date of ICU admission till date of event (death).

Time frame: From hospital admission until 30 days after hospital admission.

Mechanical power over time

Changes in mechanical power over time following initiation of invasive mechanical ventilation.

Time frame: At 1, 6, 12, and 24 hours after initiation of invasive mechanical ventilation.

Successful weaning from mechanical ventilation

Correlation between Mechanical power and successful weaning from mechanical ventilation .Successful weaning is defined as successful extubation without the need for re-intubation or noninvasive ventilation (NIV) within the following 48 hours.

Time frame: From intubation until successful weaning( successful extubation without need for ventilatory support within the following 48 hours)