Open Suction vs. Closed Suction in ARDS

Study Overview
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Brief Summary
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The alveoli tend to collapse in patients with ARDS. Endotracheal aspiration may increase alveolar collapse by decreasing the end-expiratory lung volume. The hypothesis is that closed endotracheal aspiration led to less end-expiratory volume loss when compared to open endotracheal aspiration.

Official Title
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Effect of Endotracheal Aspiration on End-expiratory Lung Volume in Patients With ARDS, Comparison of Open vs. Closed Suction, A Randomize Cross-over Study

Conditions
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Acute Respiratory Distress Syndrome

Intervention / Treatment
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* Procedure: Endotracheal aspiration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mechanically ventilated due to ARDS Exclusion Criteria: Hemodynamically unstable Air leaks syndrome (pneumothorax) Higher level of FiO2 (>60%) Chronic obstructive pulmonary disease

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: Screening
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: This is a crossover study and suction procedure was made in a random order with 60 minutes wash out period between two suction maneuvers. Patients were randomized after intubation; randomization was made with sealed envelopes. All patients mechanically ventilated with lung protective ventilation strategy. Before the suctioning the patients ventilated with 100% of oxygen for 60 seconds. In open suction, the patient was disconnected from mechanical ventilator, the aspiration catheter advanced until resistance met after that the catheter withdraw 1 cm before aspiration. During endotracheal suctioning a negative pressure applied two times for 5 seconds. The negative pressure was set 150 mmHg. All suctioning maneuvers performed by intensivists.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Open Suction<br>Endotracheal aspiration will perform after the patient disconnect from mechanical ventilation | Procedure: Endotracheal aspiration<br>* Clearance of endotracheal secretions via a catheter.<br>|
| Other: Closed Suction<br>Endotracheal aspiration will perform without disconnection from mechanical ventilation | Procedure: Endotracheal aspiration<br>* Clearance of endotracheal secretions via a catheter.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| End expiratory lung volume (EELV) | End expiratory lung impedance (EELI) will be measured wit electric impedance tomography. Change in EELI representative of change in EELV. | One minute before suctioning, 1, 10, 20, 30 minutes after suctioning | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Endotracheal aspiration, Electric impedance tomography