Sigh in Patients With Acute Hypoxemic Respiratory Failure and ARDS: The PROTECTION Pilot Randomized Clinical Trial

Autor: Mauri, T., Foti, G., Fornari, C., Grasselli, G., Pinciroli, R., Lovisari, F., Tubiolo, D., Volta, C. A., Spadaro, S., Rona, R., Rondelli, E., Navalesi, P., Garofalo, E., Knafelj, R., Gorjup, V., Colombo, R., Cortegiani, A., Zhou, J. -X., D'Andrea, R., Calamai, I., Gonzalez, A. V., Roca, O., Grieco, D. L., Jovaisa, T., Bampalis, D., Becher, T., Battaglini, D., Ge, H., Luz, M., Constantin, J. -M., Ranieri, M., Guerin, C., Mancebo, J., Pelosi, P., Fumagalli, R., Brochard, L., Pesenti, A., Papoff, A., Di Fenza, R., Gianni, S., Spinelli, E., Lissoni, A., Abbruzzese, C., Bronco, A., Villa, S., Russotto, V., Iachi, A., Ball, L., Patroniti, N., Spina, R., Giuntini, R., Peruzzi, S., Menga, L. S., Fossali, T., Castelli, A., Ottolina, D., Garcia-De-Acilu, M., Santafe, M., Schadler, D., Weiler, N., Carvajal, E. R., Calvo, C. P., Neou, E., Wang, Y. -M., Zhou, Y. -M., Longhini, F., Bruni, A., Leonardi, M., Gregoretti, C., Ippolito, M., Milazzo, Z., Querci, L., Ranieri, S., Insom, G., Berden, J., Noc, M., Mikuz, U., Arzenton, M., Lazzeri, M., Villa, A., Barreto, B. B., Rios, M. N. O., Gusmao-Flores, D., Phull, M., Barnes, T., Musarat, H., Conti, S.
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
RCT
Randomized Control Trial
VFDs
Ventilator- free days
sigh
PaO2/FiO2 ratio
Arterial Partial Pressure of O2/ Fraction of Inspired Oxygen
SpO2/FiO2 ratio
Peripheral Oxygen Saturation/ Fraction of Inspired Oxygen
Pilot Projects
ESICM
European Society of Intensive Care Medicine
NO
Positive-Pressure Respiration
ICU
Intensive Care Unit
Vt
Tidal Volume
SBT
Spontaneous Breathing Trial
Intubation
Intratracheal
Humans
PEEP
Positive End Expiratory Pressure
RR
Respiratory Rate
FiO2
Fraction of Inspired Oxygen
ARDS
feasibility
pressure support
ventilation
Aged
Female
Middle Aged
Respiratory Distress Syndrome
Respiratory Insufficiency
Respiratory Mechanics
Original Research
GEE
Generalize Estimate Equation
RASS
Richmond Agitation- Sedation Scale
ARDS
Acute Respiratory Distress Syndrome
P-SILI
Patient - Self Inflicted Lung Injury
AHRF
Acute Hypoxemic Respiratory Failure
PBW
Predicted Body Weight
PSV
Pressure Support Ventilation
SOFA
Sequence Organ Failure Assessment
Intratracheal
SAPS II
Simplified Acute Physiology Score II
SpO2
Peripheral Oxygen Saturation
PaCO2
Arterial Partial Pressure of CO2
TRALI
Transfusion-Related Acute Lung Injury
BMI
Body Mass Index
Intubation
MV
Mechanical Ventilation
Zdroj: Chest
CHEST
r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname
ISSN: 0012-3692
Popis: BACKGROUND: Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase release of surfactant. RESEARCH QUESTION: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? STUDY DESIGN AND METHODS: We conducted a multicenter noninferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or ARDS undergoing PSV. Patients were randomized to the no-sigh group and treated by PSV alone, or to the sigh group, treated by PSV plus sigh (increase in airway pressure to 30 cm H2O for 3 s once per minute) until day 28 or death or successful spontaneous breathing trial. The primary end point of the study was feasibility, assessed as noninferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiologic parameters in the first week from randomization, 28-day mortality, and ventilator-free days. RESULTS: Two-hundred and fifty-eight patients (31% women; median age, 65 [54-75] years) were enrolled. In the sigh group, 23% of patients failed to remain on assisted ventilation vs 30% in the no-sigh group (absolute difference, -7%; 95% CI, -18% to 4%; P = .015 for noninferiority). Adverse events occurred in 12% vs 13% in the sigh vs no-sigh group (P = .852). Oxygenation was improved whereas tidal volume, respiratory rate, and corrected minute ventilation were lower over the first 7 days from randomization in the sigh vs no-sigh group. There was no significant difference in terms of mortality (16% vs 21%; P = .337) and ventilator-free days (22 [7-26] vs 22 [3-25] days; P = .300) for the sigh vs no-sigh group. INTERPRETATION: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.
Databáze: OpenAIRE
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