Phrenic Nerve Block to Mitigate Self-inflicted Lung Injury

• Status: Completed
• Trial end date: 2020-09-09
• Target enrollment: 0
• Participant gender: All

Summary

The purpose of this single-centered, proof of concept study is to determine whether it is feasible to perform a phrenic nerve block to reduce diaphragm electrical activity and, therefore, inspiratory effort and if such block reduces self-inflicted lung injury on patients under mechanical ventilation on spontaneous breathing. Ten patients will be monitored with electrical impedance tomography, NAVA catheter, and esophageal balloon. Using a nerve stimulator and an ultrasound, we will identify the phrenic nerve on its cervical portion bilaterally and administer perineural low-dose lidocaine. Diaphragm electrical activity, transpulmonary pressure and data on ventilation distribution will be continuously collected. The study will be over once the patient presents the same diaphragm electrical activity and transpulmonary pressure as before the phrenic nerve block.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of Sao Paulo General Hospital
• Treatments: Anesthetics; Anesthetics, Local; Lidocaine

Criteria

Inclusion Criteria:

• Age > 17 years-old;

• Under mechanical ventilation on spontaneous breathing, capable of triggering the ventilator with P/F < 300;

• Tidal volume > 10ml/kg with inspiratory pressure of 12 cmH2O OR driving pressure > 15 cm H2O with inspiratory pressure of 12 cmH2O

Exclusion Criteria:

• Use of neuromuscular blocking agents less than 3h;

• Richmond Agitation-Sedation Scale (RASS) > 0;

• Arterial pH < 7.25;

• Hemodynamically unstable or with increasing doses of vasopressors in the last 2h;

• Intracranial hypertension;

• Thoracic or abdominal tubes;

• Any neuromuscular disease;

• Spinal injury;

• Ascitis;

• Thoracic burn injury;

• Tetanus;

• Pregnancy.