To predict the influence of PEEP on Pms and eH.
ID
Source
Brief title
Condition
- Other condition
- Heart failures
- General system disorders NEC
Synonym
Health condition
Mechanische beademing
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Pms measured at baseline, changes in Pms during increases in PEEP.
Secondary outcome
Not applicable
Background summary
The assessment of the cardiovascular state in critically ill patients is
subject to difficulties in terms of the fact that several hemodynamic
parameters, for example mean arterial blood pressure (MAP) and cardiac output
(CO) supply insufficient information about the circulating volume and cardiac
performance. There is a clinical need to adequate determination of
intravascular volume status. However, in determining the fluid status of a
patient, the lack of appreciation of the venous side of the circulation
persists today, which is greatly due to the inability to appropriately assess
the venous side of the circulation. The importance of the venous part of the
circulation is moreover reflected by the fact that an increase in venous
resistance does reduce CO many times more than a similar increase in arterial
resistance. Mean systemic filling pressure (Pms), which is defined as the
pressure equal to the pressure which would be measured if the heart should
suddenly stop pumping and all (arterial and venous) the pressures in the entire
circulatory system should be brought to equilibrium instantaneously, is a good,
complete and reliable reflection of the total intravascular fluid compartment.
Application of positive-end-expiratory-pressure (PEEP) is used in almost all
patients requiring mechanical ventilation in order to avoid lung collapse and
impairment of arterial oxygen saturation. However, application on PEEP also
decreases venous return and therefore results in a decrease in cardiac output.
Therefore, this manoeuver also reflects an important clinical objective.
Study objective
To predict the influence of PEEP on Pms and eH.
Study design
Prospective, observational study
Study burden and risks
Incremental levels of positive end-expiratory pressure with tidal volumes less
than 8 ml/Kg is a very frequently used bedside strategy as part of a protective
manoeuver for lung alveolar recruitment in mechanically ventilated patients.
There are no risks involved in this procedure because it is a well tolerated
manoeuver without any great hemodynamic effect. Small risk of bleeding at
femoral artery puncture site.
Michelangelolaan 2
Eindhoven 5623 EJ
NL
Michelangelolaan 2
Eindhoven 5623 EJ
NL
Listed location countries
Age
Inclusion criteria
All mechanically ventilated patients post-cardiac surgery pre-operatively equipped with a PICCO®.
Exclusion criteria
Circulatory assist devices, pulmonary contraindications, high abdominal cavity pressure, hemodynamic instability.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL47907.060.14 |