FRC Guided Therapy in Acute Respiratory Failure

Study Overview
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Brief Summary
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In ventilated patients with acute respiratory failure endotracheal suctioning may lead to alveolar derecruitment, which can be monitored by means of functional residual capacity (FRC) measurements. Regional distribution of ventilation can be followed at bedside using electrical impedance tomography. The investigators hypothesize that a FRC guided recruitment strategy, aimed at restoring a baseline FRC value after open endotracheal suctioning, improves oxygenation and regional distribution of ventilation. In addition the investigators research the impact of such a strategy on the inflammatory response to mechanical ventilation.

Official Title
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Functional Residual Capacity Guided Alveolar Recruitment Strategy in Patients With Acute Respiratory Failure After Cardiac Surgery

Conditions
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Mechanical Ventilation, Acute Respiratory Failure, Cardiac Surgery

Intervention / Treatment
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* Procedure: alveolar recruitment manoeuvre


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: need for mechanical ventilation due to respiratory failure after cardiac surgery Exclusion Criteria: circulatory failure, eg. need for high doses of inotropes or extracorporal cardiac support

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: FRC guided<br>Patients receive an alveolar recruitment manoeuvre if FRC falls below 94% of baseline FRC | Procedure: alveolar recruitment manoeuvre<br>* Increase of airway pressures in a stepwise manner from set peak inspiratory pressure/ positive end-expiratory pressure up to 40/15 mbar and back over 2 minutes.<br>|
| Active Comparator: Saturation guided<br>Patients receive an alveolar recruitment manoeuvre if peripheral oxygen saturation falls below 90% | Procedure: alveolar recruitment manoeuvre<br>* Increase of airway pressures in a stepwise manner from set peak inspiratory pressure/ positive end-expiratory pressure up to 40/15 mbar and back over 2 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Regional ventilation | Regional distribution of ventilation over 6 hours of treatment | 6 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| arterial oxygenation and inflammation | Changes of arterial oxygenation and inflammatory parameters in the blood during 6 hours of treatment | 6 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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functional residual capacity, electrical impedance tomography, inflammatory parameters