FLOW VERSUS PRESSURE TRIGGERING IN MECHANICALLY VENTILATED ACUTE RESPIRATORY FAILURE PATIENTS

Abstract

This study was conducted in the Respiratory Intensive Care Unit of Thoracic Medicine Department, Mansoura University Hospital, during the period from July 2011 to August 2013 after fulfilling departmental ethical committee requirements and having oral consent of the patients or their surrogate. The study aimed at comparing pressure- versus flow- triggering in ventilating patients with acute respiratory failure. In this clinical trial one hundred patients with acute respiratory failure of pulmonary origin were randomly assigned into two groups; 50 patients ventilated with pressure triggering and 50 patients with flow triggering. The primary end points were weaning duration, evaluating patient/machine synchronization, total duration of ventilation and ICU stay as well, time under sedation and occurrence of complications. Mortality was considered as secondary end point. Exclusion criteria included: a) Extra pulmonary causes of acute respiratory failure. b) Non medical causes of acute respiratory failure e.g. trauma. c) Patients aged above 70 year ,or below 18 year . d) Post cardiac arrest. e) Advanced malignancy with or without metastasis. • Patients were assorted into obstructive, restrictive and combined pulmonary disease according to their past medical history, and clinical and radiological assessment. • All selected patients were intubated and connected to the ventilator using; Inspiration Events ventilator. Settings were tailored according to the clinical condition indicating mechanical ventilation and the monitoring of clinical, laboratory and lung mechanics data along the course of ventilation. The medical therapy and nursing care were individualized according to the original problem indicating mechanical ventilation. Analgo/sedation was achieved with Midazolam (bolus and/or infusion) and/or fentanyl (bolus and/or infusion) with dose adjustment according to clinical indication and response considering morning sedation vacation for reassessment.