Sigh Ventilation to Reduce the Incidence and/or the Severity of the Acute Respiratory Distress Syndrome
Abstract
Fiscal Year 2014 Peer Reviewed Medical Research Program Topic Area: "Preventive techniques and therapeutics to reduce the incidence of acute respiratory syndrome after acute lung injury in trauma patients." Background: Patients who experience trauma have an increased risk of developing severe lung injury that is termed the Acute Respiratory Distress Syndrome (ARDS). The mortality of patients who develop ARDS is approximately 16% even when the best possible therapies are utilized. When patients with ARDS require mechanical ventilation (i.e., use of a breathing machine) to assure they receive sufficient oxygen, they are at risk of developing an additional type of lung injury termed ventilator-induced lung injury (VILI). Numerous studies in the medical literature indicate, however, that VILI can occur in normal lungs (that is, in absence of ARDS) as a result of the fact that when we use a breathing machine, the current practice is to administer the same size breath with each inhalation. Rationale: The rationale for this study is based on the fact that normal humans take deep breaths (i.e., they sigh) approximately 10 times/hour and sighing has been shown to improve lung function and prevent VILI. Hypotheses: Using sigh breaths when breathing machines are needed to support patients who have experienced trauma will reduce the incidence, severity, morbidity, and/or the mortality of ARDS. Specific Aims: We will determine if including sigh breaths, given once every 5 minutes, to patients who experience trauma and are therefore predisposed to developing ARDS will: (1) decrease the likelihood of developing ARDS when they do not have ARDS at the time they start receiving mechanical ventilation; (2) decrease the likelihood of developing moderate and/or severe ARDS when they have mild ARDS at the time the time they start receiving mechanical ventilation; (3) decrease the likelihood that patients at risk of developing ARDS will die; (4) decrease the likelihood that patients who develop ARDS will die; (5) shorten the time that patients with ARDS require a breathing machine; and (6) decrease the number of days patients with ARDS require hospitalization in intensive care units. Study Design: We will randomly allocate patients with trauma to receive either their usual care or to receive their usual care but with the addition of a single sigh breath every 5 minutes. Clinical Impact: Approximately 16% of patients with ARDS die despite using the most effective therapies available. Approximately 24% of patients who experience trauma develop ARDS developing after starting mechanical ventilation. If the number of people who develop ARDS can be reduced by adding sighs, fewer patients will die following trauma. Military Relevance: Sigh ventilation is a simple intervention for military personnel who are victims of trauma that can be initiated as soon as invasive mechanical ventilation is started.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 29, 2016
- Source ID
- W81XWH1510504
Entities
People
- Richard Albert
Organizations
- United States Army