Track topics on Twitter Track topics that are important to you
Surveillance of the lungs for bacteria is routinely undertaken in artificially ventilated patients as these individuals are at high risk of developing pneumonia. Knowledge of the types of bacteria present allows the rapid treatment with the correct antibiotics if a pneumonia develops. Surveillance is undertaken using a technique called non-directed bronchoalveolar lavage (NBL), which can be performed by the bedside nurse. This involves suctioning some of the lung secretions into a sample pot and sending it to the microbiology laboratory to identify any bacteria present. When this procedure is performed there is some collapse of the lung due to escaping gas. The purpose of this study is:
1. To use a non-invasive imaging technique known as electrical impedance tomography (EIT) to measure the amount of lung collapse during an NBL. Half of the patients in the study will have a one-way adapter valve connected to the breathing circuit. This adapter is designed to make the insertion of a suction catheter easier and prevent the loss of gas.
2. Look at which region of the lung the sample is being collected from as the suction tube used to take the samples may pass into either the left or right lung.
EIT is a simple non-invasive technique which has been in use for many years. It uses pairs of electrodes around the chest through which imperceptible currents are passed. A computer shows an image of which parts of the lungs have the most or least air in them. This has the advantage over other imaging techniques in critical care that it does not use radiation and gives a real time picture at the bedside of the variations in ventilation throughout the lungs.
This study has two objectives. The first is to measure changes in lung ventilation using EIT during the performance of an NBL with and without a one-way adapter valve attached to the catheter mount. This will be done by randomising half of the patients to having the one-way adapter valve attached to the catheter mount. Assignment will be by randomisation.
The second objective of the study is to locate the placement of catheter tips during the performance of NBLs, using electrical impedance tomography.
Equipment: A sixteen-electrode single frequency electrical impedance tomography device with on-line image analysis (CareFusion). One-way adapter valves which attach to the catheter mount (CareFusion).
Study Population: Critically ill adult patients admitted to the intensive care unit at the University Hospital of Wales Cardiff in whom NBLs are performed as part of their routine care.
Recruitment: All patients satisfying inclusion and exclusion criteria, admitted to the adult ICU at the University Hospital of Wales from the start date of the study will be considered eligible for recruitment. Patients identified by the duty consultant will be notified to the research team. Patients will be randomly allocated to have NBLs performed with or without the one-way valve attached to the catheter mount.
Since this is an observational pilot study a minimum of fifty patients will be identified.
Interventions: The second cohort of patients will have NBLs performed with the one-way adapter connected to the catheter mount, otherwise there will be no change will be made to the normal standard of care.
Method: Following cleaning of the skin with alcohol wipes sixteen ECG electrodes will be placed equidistantly from one another midway between sternum and umbilicus. A reference electrode will be placed on the right hand side of the chest. NBLs will be undertaken according to routine standards of care. In brief, this involves pre-oxygenating the patient, and inserting a suction catheter attached to a 20ml saline filled syringe through the catheter mount (25 patients) or adapter with one-way valve connected to the catheter mount (25 patients) until resistance is met. The saline is instilled and then slowly withdrawn to obtain a sample. Since saline is conductive, instillation results in a change in local impedance which is detected by the array of electrodes. The image obtained will identify into which region of the lung the catheter is placed. Any changes in the gas content of lung (due to loss of PEEP) will be manifest as changes in lung impedance and reflects a change in regional ventilation. NBLs are undertaken when clinically indicated and patients may have more than one recoding undertaken up to a maximum of three times.
Collection of other data: Baseline demographics of patients will be recorded, including age, sex, APACHE II score, co-morbidities, diagnosis, days from hospital admission. Ventilator settings - mode, inspired oxygen fraction, tidal and minute ventilation, compliance, PEEP and mean airway pressure will be recorded.
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
CSC100 - Verso airway access adapter CareFusion
Adult Critical Care, University Hospital of Wales
Enrolling by invitation
Cardiff and Vale University Health Board
Published on BioPortfolio: 2014-08-27T03:12:55-0400
The general aim of this 1-day, open label, non-randomised, trial is to characterize the performance of two adapter devices designed to permit use of the Respimat® inhaler with patients re...
Literature shows that anaesthetists have a low success-rate when trying to access the airway percutaneously in case of failed ventilation and intubation. The study will investigate anaest...
Microdermics Inc. is a British Columbia-based Canadian incorporation primarily focusing on microneedle-based painless and effective drug delivery systems.The Microneedle Adapter (model UAR...
This study will clinically evaluate a newly developed respiratory monitor - pneuRIP. The pneuRIP uses Respiratory Inductance Plethysmography (RIP) bands to measure key breathing indices no...
This is a survey of airway codes, which are emergency mobile phone requests for anaesthetic help to manage acute airway crises in the hospital (out of theatre, out of Surgical Intensive Ca...
The Institute of Medicine's report, Dying in America, highlights the critical need for the widespread implementation of palliative care to improve end-of-life care. Approximately 20% of all deaths in ...
Gentle ventilation with optimal oxygenation is integral to prevention of chronic lung disease in the extremely low birth-weight (ELBW) infant. Various types of noninvasive ventilation are used in neon...
Measuring patients satisfaction is an important part of continuous quality improvement in health care. In intensive care, family satisfaction is often used as a proxy for patient experience. At presen...
Following extubation in the intensive care unit (ICU), upper airway (UA) edema and respiratory depressants may promote UA dysfunction. We tested the hypothesis that opioids increase the risk of sleep ...
The cornerstone of emergency management of sepsis is early, goal-directed therapy. The purpose of this study was to evaluate the effect of intraosseous (IO) vs. intravenous (IV) access for resuscitati...
Hospital units providing continuous surveillance and care to acutely ill infants and children. Neonates are excluded since INTENSIVE CARE UNITS, NEONATAL is available.
Organization of medical and nursing care according to the degree of illness and care requirements in the hospital. The elements are intensive care, intermediate care, self-care, long-term care, and organized home care.
Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility.
A measure of the mortality and morbidity rates among patients who receive CRITICAL CARE and INTENSIVE CARE as determined from the date of hospital discharge or release.
The hospital unit in which patients with acute cardiac disorders receive intensive care.
Pulmonary relating to or associated with the lungs eg Asthma, chronic bronchitis, emphysema, COPD, Cystic Fibrosis, Influenza, Lung Cancer, Pneumonia, Pulmonary Arterial Hypertension, Sleep Disorders etc Follow and track Lung Cancer News ...
Pneumonia (bronchopneumonia, lobar pneumonia and double pneumonia) is inflammation (swelling) of the tissue in one or both of your lungs. It is usually caused by an pneumococcal infection caused by bacteria called Streptococcus pneumoniae. However,...