Clinical trial NCT05702411: Air Stacking Technique For Pulmonary Reexpansion
Official title: Air Stacking Technique For Pulmonary Reexpansion In The Ventilator After Expiratory Pause During Aspiration In Closed System
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Critical Care
Keywords: pulmonary reexpansion
air stacking
mechanical ventilation
Lead sponsor: Hospital Nossa Senhora da Conceicao
Sponsor class: OTHER
First posted: 2023-01-27
Enrollment: 39
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: TREATMENT

Brief summary: A cross-over randomized clinical trial carried out at the Intensive Care Unit. Patients who are on mechanical ventilation for more than 24 hours will be included in the study. The following techniques will be applied: aspiration in a closed system with an expiratory pause of 10 seconds associated to hyperinflation maneuver with a mechanical ventilator with the Air Stacking technique and aspiration technique in a closed system of aspiration with an expiratory pause of 10 seconds.

Detailed description: After randomization, all patients will be positioned in dorsal decubitus with the head elevated at 30 degrees and will be aspirated once with a closed suction system and with a vacuum limited to 150 cmH2O.

Two hours later, hemodynamic and ventilatory parameters will be collected and recorded.

If randomized to Protocol 1 (Air Stacking technique), the aspiration technique with closed system and expiratory pause will be performed three times during a 30-second interval, with a probe of the same caliber and the same vacuum value. One ml of saline solution will be instilled in the aspiration system to washing the closed suction circuit.

Immediately after, the Air Stacking maneuvers will be performed. If Protocol 2 (No Air Stacking technique), only tracheal suction with closed system.

Hemodynamic and ventilatory parameters will be collected after 1, 10 and 30 minutes of application. The secretions aspirated into the collection flasks will then be weighed, on a precision balance, by a collaborator blinded that is not part of the study, and the weight will be transcribed to the data collect.

Eligibility criteria: Inclusion Criteria:

* patients 18 years or older
* patients on mechanical ventilation for more than 48 hours
* patients on volume or pressure controlled ventilatory mode
* patients hemodynamically stable (equal mean blood pressure or more than 60 mmHg, and dose of Norepinephrine less than 1μg / Kg / minute)
* patients whose legal representatives authorize participation in the study.

Exclusion Criteria:

* undrained pneumothorax and hemothorax, and emphysema subcutaneous
* fracture of ribs
* ventilatory parameters with peak pressure greater than 40 cm/H2O

Primary outcomes:
measure: Tidal Volume (VT) (ml)
timeFrame: At 30-minute after the application of the studied technique.
Secondary outcomes:
measure: Weight of secretion aspirated (grams)
timeFrame: Immediately after the application of one of the protocols.
measure: Peripheral arterial oxygen saturation (SpO2) (%)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Peak inspiratory pressure (PIP) (cm H2O)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: End expiratory pressure (PEEP) (cmH2O)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Air trapping (AUTO-PEEP) (cmH2O)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Mechanical ventilation circuit pressure (cmH2O)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Endotracheal tube diameter (ETT) (mm)
timeFrame: 1-minute after the application of the studied technique.
measure: Dynamic compliance (Cd) (ml/cmH2O)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Resistance (R) (L/s)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Drive pressure (cmH2O)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Heart rate (HR) (beats per minute)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Respiratory rate (RR) (breaths per minute)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
measure: Mean arterial pressure (MAP) (mmHg)
timeFrame: 1, 10 and 30-minute after the application of the studied technique.
Other outcomes:
Locations:
city: Porto Alegre
country: Brazil
facility: Hospital Cristo Redentor
state: RS
Study officials:
affiliation: Grupo Hospitalar Conceição
name: Fernanda M Kutchak, Master
role: PRINCIPAL_INVESTIGATOR
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