Chest Wall Influence on Respiratory System Mechanics in Morbidly Obese Patients
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension), Obesity Weight Loss |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/16/2015 |
| Start Date: | August 2013 |
| End Date: | December 2014 |
| Contact: | Lorenzo Berra, MD |
| Email: | lberra@partners.org |
| Phone: | 6176437733 |
The goal of this study is to describe the influence of the chest wall on the respiratory
system mechanics in morbidly obese patients and in patients with high intra-abdominal
pressure.
The effects of increasing and decreasing positive end-expiratory pressure (PEEP) on chest
wall and total respiratory system mechanics, lung volumes and gas exchange will be
evaluated, both during controlled and assisted mechanical ventilation.
Patients will be studied, first, during the acute phase of respiratory failure, when
requiring intubation and controlled mechanical ventilation. Then, patients will be evaluated
again during weaning from the ventilator to assess the influence of PEEP in assisted
ventilation prior to extubation.
system mechanics in morbidly obese patients and in patients with high intra-abdominal
pressure.
The effects of increasing and decreasing positive end-expiratory pressure (PEEP) on chest
wall and total respiratory system mechanics, lung volumes and gas exchange will be
evaluated, both during controlled and assisted mechanical ventilation.
Patients will be studied, first, during the acute phase of respiratory failure, when
requiring intubation and controlled mechanical ventilation. Then, patients will be evaluated
again during weaning from the ventilator to assess the influence of PEEP in assisted
ventilation prior to extubation.
The goal of this study is to describe the influence of the chest wall on the respiratory
system mechanics. Investigators want to describe how extreme obesity and Intra-Abdominal
Hypertension (IAH) affect normal respiratory system behavior. The effects of increasing and
decreasing positive end-expiratory pressure (PEEP) on respiratory system mechanics, lung
volumes and gas exchange will be evaluated, both during controlled and assisted mechanical
ventilation.
Investigators will record and compare lung volumes, airway and transpulmonary pressure, gas
exchange and hemodynamic changes caused by variations of PEEP. Patients will be studied,
first, during the acute phase of respiratory failure, when requiring intubation and
controlled mechanical ventilation. Patients will then again be evaluated during weaning from
the ventilator to assess the influence of PEEP in assisted ventilation prior to extubation.
Investigators believe that assessment of the transpulmonary pressure and lung volumes is
essential to correctly evaluate respiratory system function in patients in which the
relationship between the lung and chest wall is altered. Improper mechanical ventilation
leads to lung damage. High ventilatory volume/pressure are associated with lung
overdistension, while low volume/pressure leads to lung collapse and cyclic opening and
closing of alveoli. All of these mechanisms have been associated with ventilator induced
lung injury and poorer outcomes. Adequate PEEP and transpulmonary pressure are fundamental
in preventing this vicious cycle.
system mechanics. Investigators want to describe how extreme obesity and Intra-Abdominal
Hypertension (IAH) affect normal respiratory system behavior. The effects of increasing and
decreasing positive end-expiratory pressure (PEEP) on respiratory system mechanics, lung
volumes and gas exchange will be evaluated, both during controlled and assisted mechanical
ventilation.
Investigators will record and compare lung volumes, airway and transpulmonary pressure, gas
exchange and hemodynamic changes caused by variations of PEEP. Patients will be studied,
first, during the acute phase of respiratory failure, when requiring intubation and
controlled mechanical ventilation. Patients will then again be evaluated during weaning from
the ventilator to assess the influence of PEEP in assisted ventilation prior to extubation.
Investigators believe that assessment of the transpulmonary pressure and lung volumes is
essential to correctly evaluate respiratory system function in patients in which the
relationship between the lung and chest wall is altered. Improper mechanical ventilation
leads to lung damage. High ventilatory volume/pressure are associated with lung
overdistension, while low volume/pressure leads to lung collapse and cyclic opening and
closing of alveoli. All of these mechanisms have been associated with ventilator induced
lung injury and poorer outcomes. Adequate PEEP and transpulmonary pressure are fundamental
in preventing this vicious cycle.
Inclusion Criteria:
- 18 years or older
- Requiring intubation and mechanical ventilation
- BMI≥40 kg/m2 or IAP≥12 mmHg
Exclusion Criteria:
- Known presence esophageal varices
- Recent esophageal trauma or surgery
- Severe thrombocytopenia (PTL≤10,000/mm3)
- Severe coagulopathy (INR≥2)
- Presence of pneumothorax
- Pregnancy
- Patients with diagnosed moderate to severe ARDS or with poor oxygenation index
(PaO2/FiO2 < 200 mmHg)
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