Electrical impedance tomography in evaluating the effects of non-invasive ventilation in the post-operative cardiac surgery: randomized controlled clinical trial

2018 ◽  
Author(s):  
Alita De Novaes ◽  
Armèle Dornelas De Andrade ◽  
Shirley Campos ◽  
Norma Módolo ◽  
Christian Gonçalves ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Electrical Impedance ◽  
Controlled Clinical Trial ◽  
Invasive Ventilation ◽  
Randomized Controlled Clinical Trial ◽  
Impedance Tomography ◽  
Non Invasive ◽  
Randomized Controlled ◽  
Non Invasive Ventilation

scholarly journals A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation

2021 ◽  
Vol 12 ◽  
Author(s):  
Michela Rauseo ◽  
Lucia Mirabella ◽  
Donato Laforgia ◽  
Angela Lamanna ◽  
Paolo Vetuschi ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Invasive Ventilation ◽  
Ventilatory Strategy ◽  
Impedance Tomography ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Icu Discharge ◽  
Study Results

Background: Different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia phenotypes were described that match with different lung compliance and level of oxygenation, thus requiring a personalized ventilator setting. The burden of so many patients and the lack of intensive care unit (ICU) beds often force physicians to choose non-invasive ventilation (NIV) as the first approach, even if no consent has still been reached to discriminate whether it is safer to choose straightforward intubation, paralysis, and protective ventilation. Under such conditions, electrical impedance tomography (EIT), a non-invasive bedside tool to monitor lung ventilation and perfusion defects, could be useful to assess the response of patients to NIV and choose rapidly the right ventilatory strategy.Objective: The rationale behind this study is that derecruitment is a more efficient measure of positive end expiratory pressure (PEEP)-dependency of patients than recruitment. We hypothesized that patients who derecruit significantly when PEEP is reduced are the ones that do not need early intubation while small end-expiratory lung volume (ΔEELV) variations after a single step of PEEP de-escalation could be predictive of NIV failure.Materials and Methods: Consecutive patients admitted to ICU with confirmed SARS-CoV-2 pneumonia ventilated in NIV were enrolled. Exclusion criteria were former intubation or NIV lasting > 72 h. A trial of continuos positive airway pressure (CPAP) 12 was applied in every patient for at least 15 min, followed by the second period of CPAP 6, either in the supine or prone position. Besides standard monitoring, ventilation of patients was assessed by EIT, and end-expiratory lung impedance (ΔEELI) (%) was calculated as the difference in EELI between CPAP12 and CPAP6. Tidal volume (Vt), Ve, respiratory rate (RR), and FiO2 were recorded, and ABGs were measured. Data were analyzed offline using the dedicated software. The decision to intubate or continue NIV was in charge of treating physicians, independently from study results. Outcomes of patients in terms of intubation rate and ICU mortality were recorded.Results: We enrolled 10 male patients, with a mean age of 67 years. Six patients (60%) were successfully treated by NIV until ICU discharge (Group S), and four patients failed NIV and were intubated and switched to MV (Group F). All these patients died in ICU. During the supine CPAP decremental trial, all patients experienced an increase in RR and Ve. ΔEELI was < 40% in Group F and > 50% in Group S. In the prone trial, ΔEELI was > 50% in all patients, while RR decreased in Group S and remained unchanged in Group F.Conclusion: ΔEELI < 40% after a single PEEP de-escalation step in supine position seems to be a good predictor of poor recruitment and CPAP failure.

scholarly journals Effect of remimazolam besylate compared with propofol on the incidence of delirium after cardiac surgery: study protocol for a randomized trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maopeng Yang ◽  
Xinyan Liu ◽  
Daqiang Yang ◽  
Yahu Bai ◽  
Bingxin Qin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Cognitive Disorder ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Double Blind ◽  
Randomized Controlled

Abstract Background Delirium is an acute cognitive disorder that presents with fluctuation in cognition, apathy, and non-organized thinking, resulting in increased morbidity, mortality, intensive care unit (ICU) stay, and total healthcare costs. In patients undergoing cardiac surgery, delirium also increases the risk of postoperative complications, such as respiratory insufficiency, sternum instability, and need for re-operation of the sternum. This study aims to understand the incidence of delirium in patients after cardiac surgery in patients sedated with remimazolam besylate versus propofol. Methods In this prospective, double-blind, randomized controlled clinical trial, we aim to recruit 200 patients undergoing cardiac surgery between January 1, 2021, and December 31, 2021, who will be randomized to receive either remimazolam besylate or propofol infusions postoperatively, until they are extubated. The primary outcome is the incidence of delirium within 5 days after surgery. Secondary outcomes include the time of delirium onset, duration of delirium, ICU length of stay, hospital length of stay, and mechanical ventilation time. Discussion The key objective of this study is to assess whether remimazolam besylate reduces the incidence of delirium in patients after cardiac surgery compared to propofol sedation. In this preliminary randomized controlled clinical trial, we will test the hypothesis that the use of remimazolam besylate lowers the incidence of delirium when compared to propofol in patients undergoing cardiac surgery. Trial registration chictr.org.cn ChiCTR2000038976. Registered on October 11, 2020

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