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A randomized crossover clinical trial conducted in an Intensive Care Unit of the Hospital de Clinicas de Porto Alegre (HCPA) to compare the efficacy of the two techniques on the amount of aspirated pulmonary secretion and pulmonary mechanics: aspiration of the closed system following an expiratory pause with mechanical ventilator for 5 seconds (5-Second Expiratory Pause) and aspiration of the closed system following an expiratory pause with mechanical ventilator for 10 seconds (10-Second Expiratory Pause).
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 of -40cm H2O. Hemodynamic and pulmonary parameters will be collected and recorded. One of the two techniques will be applied, according to randomization, and the outcomes measured. After two hours, hemodynamic and pulmonary parameters will be re-collected, and the second technique will be applied. The outcomes will be measured again.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 5-Second Expiratory Pause | Experimental | Closed system aspiration following by expiratory pause with mechanical ventilator for 5 seconds. |
|
| 10-Second Expiratory Pause | Experimental | Closed system aspiration following by expiratory pause with mechanical ventilator for 10 seconds. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 5-Second Expiratory Pause | Other | Patients on mechanical ventilation for more than 24 hours will be randomized for the first technique to be applied. This technique consists of closed system aspiration and expiratory pause with mechanical ventilator for 5 seconds. After randomization and before the application of the technique, all patients will be positioned in supine position with the headboard elevated at 30 degrees and will be aspirated once with closed aspiration system and with vacuum of -40 cm H2O. |
| Measure | Description | Time Frame |
|---|---|---|
| Weight of secretion aspirated (grams) | The secretion aspirated into the collection flask will be weighed on a precision laboratory scale. | Immediately after the application of one of the closed system aspiration techniques. |
| Measure | Description | Time Frame |
|---|---|---|
| Peripheral arterial oxygen saturation (SpO2) (%) | After the 3-second expiratory pause on the mechanical ventilator, the SpO2 will be visualized on the monitor of the patient, and the value will be noted. | One minute after the application of the studied technique. |
| Peak inspiratory pressure (PIP) (cm H2O) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Luciane FG Martins, Master | Contact | 55 51 81598395 | lfgmartins@hcpa.edu.br | |
| Silvia Vieira, PhD | Contact | 55 51 99686170 | svieira@hcpa.edu.br |
| Name | Affiliation | Role |
|---|---|---|
| Luciane FG Martins, Master | Hospital de Clínicas de Porto Alegre | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital de Clinicas de Porto Alegre | Recruiting | Porto Alegre | Rio Grande do Sul | 90035-003 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18283429 | Background | Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, Schonhofer B, Stiller K, van de Leur H, Vincent JL. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008 Jul;34(7):1188-99. doi: 10.1007/s00134-008-1026-7. Epub 2008 Feb 19. | |
| 17132121 |
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|
| 10-Second Expiratory Pause | Other | Patients on mechanical ventilation for more than 24 hours will be randomized for the first technique to be applied. This technique consists of closed system aspiration and expiratory pause with mechanical ventilator for 10 seconds. After randomization and before the application of the technique, all patients will be positioned in supine position with the headboard elevated at 30 degrees and will be aspirated once with closed aspiration system and with vacuum of -40 cm H2O. |
|
The PIP will be visualized directly at mechanical ventilation monitor, and the value will be noted. |
| One minute after the application of the studied technique. |
| End expiratory pressure (PEEP) (cmH2O) | The PEEP will be visualized directly at mechanical ventilation monitor, and the value will be noted. | One minute after the application of the studied technique. |
| Air trapping (AUTO-PEEP) (cmH2O) | The AUTO-PEEP will be visualized directly at mechanical ventilation monitor, and the value will be noted. | One minute after the application of the studied technique. |
| Mechanical ventilation circuit pressure (cmH2O) | The mechanical ventilation circuit pressure will be visualized directly at mechanical ventilation monitor, and the value will be noted. | One minute after the application of the studied technique. |
| Tidal volume (TV) (ml) | The TV will be visualized directly at mechanical ventilation monitor, and the value will be noted. | One minute after the application of the studied technique. |
| Endotracheal tube diameter (ETT) (mm) | The endotracheal tube diameter is directly written in the product package. | One minute after the application of the studied technique. |
| Dynamic compliance (Cd) (ml/cmH2O) | The Cd will be visualized directly at mechanical ventilation monitor, and the value will be noted. | One minute after the application of the studied technique. |
| Resistance (R) (L/s) | The R will be visualized directly at mechanical ventilation monitor, and the value will be noted. | One minute after the application of the studied technique. |
| Drive pressure (cmH2O) | The drive pressure will be calculated by the difference between plateau pressure and positive end-expiratory pressure in the mechanical ventilation, and the value will be noted. | One minute after the application of the studied technique. |
| Heart rate (HR) (beats per minute) | After the 3-second expiratory pause on the mechanical ventilator, the HR will be visualized on the monitor of the patient, and the value will be noted. | One minute after the application of the studied technique. |
| Respiratory rate (RR) (breaths per minute). | After the 3-second expiratory pause on the mechanical ventilator, the RR will be visualized on the monitor of the patient, and the value will be noted. | One minute after the application of the studied technique. |
| Mean arterial pressure (MAP) (mmHg) | After the 3-second expiratory pause on the mechanical ventilator, the MAP will be calculated using the systolic and diastolic blood pressure, and the value will be noted. | One minute after the application of the studied technique. |
| Luciane FG Martins | Recruiting | Porto Alegre | Rio Grande do Sul | 90035-003 | Brazil |
|
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