Comparison of the Hemodynamic Safety of Two Common Alveolar Recruitment Manoeuvres With Regard to Cardiac Output in a Surgical Intensive Care Unit

Study Overview
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Brief Summary
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Protective ventilation - combining a low tidal volume (between 6 and 8 ml/kg) and alveolar recruitment (AR) manoeuvres repeated every 30 minutes - is currently the standard of care for decreasing morbidity associated with mechanical ventilation. In contrast, there is no consensus on the type of recruitment manoeuvre, which varies from one centre to another and from one study to another. The investigators intend to compare two currently used AR techniques with regard to their ventilatory efficacy and hemodynamic safety: An end-tidal plateau at 30 cmH20 for 30 seconds. An end-tidal plateau at 10 cmH20 above the patient's plateau pressure for 30 seconds, without exceeding 30 cmH20.

Official Title
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Comparison of the Hemodynamic Safety of Two Common Alveolar Recruitment Manoeuvres With Regard to Cardiac Output in a Surgical Intensive Care Unit: a Randomized Study

Conditions
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Positive-Pressure Respiration

Intervention / Treatment
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* Device: echocardiography
* Device: Arterial oximetry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All sedated, intubated, mechanically ventilated adult patients (over-18) admitted to the surgical intensive care unit and equipped with a central venous catheter and an arterial catheter. Good echogenicity Social security coverage Exclusion Criteria: Pregnancy Cardiac arrhythmia Poor echogenicity Legal guardianship or incarceration Systolic blood pressure ≤90 mmHg Respiratory distress Patients admitted on an emergency basis (first 24 hours), i.e. not for elective surgery

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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 30 cmH20 for 30 seconds<br>plateau pressure is hold on at 30 cmH20 pour 30 seconds. The cardiac output and the lung aeration is assessed by ultrasound measures at 3 times: before, at the end of the recruitment and 30 minutes later. echocardiography - arterial oximetry | Device: echocardiography<br>* • Prospective, simultaneous recording of the cardiac output (measured non-invasively via transthoracic echocardiography) and a number of parameters commonly monitored in the surgical intensive care unit (CVP, SBP/DBP/MBP).<br>Device: Arterial oximetry<br>* measured by co-oximetry of a blood sample taken via the arterial catheter implemented for critical care<br>|
| 10 cmH20 above<br>plateau pressure is hold on at 10 cmH20 above. The cardiac output and the lung aeration is assessed by ultrasound measures at 3 times: before, at the end of the recruitment and 30 minutes later. echocardiography - arterial oximetry | Device: echocardiography<br>* • Prospective, simultaneous recording of the cardiac output (measured non-invasively via transthoracic echocardiography) and a number of parameters commonly monitored in the surgical intensive care unit (CVP, SBP/DBP/MBP).<br>Device: Arterial oximetry<br>* measured by co-oximetry of a blood sample taken via the arterial catheter implemented for critical care<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Variations in cardiac output induced by each type of AR manoeuvre |  | Day 0 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Variations in PaO2 variations induced by each type of AR manoeuvre |  | Day 0 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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alveolar recruitment, stroke volume/physiology, cardiac output/physiology