Transpulmonary Pressure Guided Weaning From Invasive Mechanical Ventilation in Obese Patients With Respiratory Failure
University of Mississippi Medical Center
Summary
This study will look at whether accounting for the amount of pressure generated by the chest wall and abdomen in a obese patient, using a measurement called transpulmonary pressure, can help shorten the amount of time patients spend on the ventilator. By decreasing the amount of time patients spend on the ventilator, they are less likely to develop complications such as infections, weakness or more procedures.
Description
Managing obese patients on the ventilator can be difficult due to the changes in their respiratory mechanics with little evidence as to best practices. This research will assess the utility of transpulmonary pressures in guiding mechanical ventilation in obese patients. This study with specifically look at whether using transpulmonary pressure guided positive end expiratory pressure (PEEP) titration for ventilation and spontaneous breathing trials (SBT) will shorten the time to liberation for obese patients on invasive mechanical ventilation for respiratory failure. The transpulmonary pressure…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * on invasive mechanical ventilation for respiratory failure for \< 48 hours * obese class II or higher (BMI greater than or equal to 35.0 kg/m2) Exclusion Criteria: * contraindications to esophageal balloon catheter placement including esophageal, nasofacial, gastrointestinal abnormalities and platelets \<10,000/microliter * known pleural disease such as persistent pneumothorax, pleural effusion, or pleurodesis * neuromuscular disease * requires chronic mechanical ventilation prior to enrollment * severe neurologic injury * known difficult airway * life expectance is le…
Interventions
- Othertranspulmonary pressure guided positive end expiratory pressure
Positive end expiratory pressure will be titrated to achieve a transpulmonary pressure of 0-2 cm H2O
- Otherstandard positive end expiratory pressure
Positive end expiratory pressure will be set to a standard 5-8 cm H2O by the clinician for spontaneous breathing trials
Location
- University of Mississippi Medical CenterJackson, Mississippi