Comparison of Mechanical Power Calculations of Volume Control and Pressure Control Modes

Overview

The management of ARDS, which is one of the important problems of intensive care patients, has gained popularity with the pandemic. Mechanical ventilation is an important life-saving treatment in ARDS patients. However, when not used correctly, it can cause Ventilator-Induced Lung Injury (VILI). Therefore, lung protective ventilation should be applied to minimize VILI in ARDS patients. Mechanical power is one of the parameters that guides intensivist in predicting VILI.

Full Title of Study: “Comparison of Mechanical Power Calculations of Volume Control and Pressure Control Modes: A Prospective Observational Study”

Study Type

• Study Type: Observational
• Study Design
  • Time Perspective: Prospective
• Study Primary Completion Date: December 27, 2021

Detailed Description

The goal of mechanical ventilation in ARDS patients is to improve oxygenation by reducing the work of breathing . With this aim, the orientation towards sensitive ventilation strategies has increased in the light of experience and scientific data from the past to the present. Today, the concept of Mechanical Power (MP) has been developed, which combines different variables, such as tidal volume, drive pressure, gas flow, respiratory rate, and PEEP, which have been associated with VILI in various studies, into a single parameter. In this study, the investigators used the simplified MP equation (MPvcv (simpl)) developed by Gattinoni et al. for power calculation in volume control mode and the simplified MP equation (MPpcv(simpl)) developed by Becher et al. for power calculation in pressure control mode. Thus, the investigators aimed to compare the volume control and pressure control modes over the concept of MP.

Interventions

• Device: Changing mechanical ventilation mode
  • On the 2nd day of intensive care hospitalization, while under deep sedation and in the controlled mode (VCV or PRVC) and in the supine position, the ventilator in the VCV mode was switched to PRVC mode for 60 minutes without changing any of the set ventilator settings (RR, PEEP, TV, I:E ratio). Likewise, if it is in PRVC mode, it is also switched to VCV mode for 60 minutes. MP values were calculated from the minute respiratory parameters of all patients with the MP formulas defined in the software.

Arms, Groups and Cohorts

• Pressure control mode group
  • On the 2nd day of intensive care hospitalization, while under deep sedation and in the controlled mode (VCV or PRVC) and in the supine position, the ventilator in the VCV mode was switched to PRVC mode for 60 minutes without changing any of the set ventilator settings (RR, PEEP, TV, I:E ratio).
• Volume control mode group
  • Likewise, if it is in PRVC mode, it is also switched to VCV mode for 60 minutes. In this way, two dependent groups were formed.

Clinical Trial Outcome Measures

Primary Measures

• Mechanical power values of different ventilation modes
  • Time Frame: 60 minutes
  • We aimed to compare the volume control and pressure control modes over the mechanical power values.

Participating in This Clinical Trial

Inclusion Criteria

• Patients with confirmed Covid-19 diagnosis in intensive care unit (ICU) and diagnosed with ARDS according to Berlin criteria – Intubated patients which treated in the supine position on the second day of ICU admission Exclusion Criteria:

• Patients with a known diagnosis of COPD – Patients experiencing hemodynamic instability during ventilation – Prone pozisyonda olan hastalar – Patients receiving inotropic support – Patients with missing data

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

• Lead Sponsor
  • Bakirkoy Dr. Sadi Konuk Research and Training Hospital
• Provider of Information About this Clinical Study
  • Sponsor
• Overall Official(s)
  • Furkan Tontu, Principal Investigator, Intensivist