The investigation of various titration techniques aimed at determining the most effective positive end expiratory pressure (PEEP) for individuals suffering from acute exacerbations of chronic obstructive pulmonary disease (AECOPD)

Study on optimal PEEP titration in patients with acute exacerbation of chronic obstructive pulmonary disease

Status

Recruiting

Phases

Unknown

Study type

Observational

Source

ISRCTN

Registry ID

ISRCTN12210765

Enrollment

Registered

2024-04-17

Start date

2022-06-01

Completion date

Unknown

Last updated

2024-04-29

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

The reasonable setting of PEEP in AECOPD patients can prevent the poor effect caused by setting too low, and the excessive lung inflation caused by setting too high Respiratory

Interventions

A cohort study was used in this study. Patients were divided into an invasive ventilation group and a non-invasive ventilation group according to clinical treatment. This study did not interfere with

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: 1. Diagnostic criteria for AECOPD met according to The 2018 GOLD definition needing noninvasive ventilation within 3 days 2. Age older than 18 years and younger than 85 years 3. Signed informed consent able to be obtained.

Exclusion criteria

Exclusion criteria: 1. Hemodynamically unstable 2. Gastrointestinal bleedings 3. Severe neurological disease 4. End-stage malignant disease 5. Interstitial lung disease 6. Chest wall deformities 7. Suffering from other organ failure 8. Cancer 9. Contraindication to use of EIT 10. Inability to cooperate with noninvasive ventilation.

Design outcomes

Primary

Measure	Time frame
In NIV group 1. The patients were ventilated at supine position with mechanical ventilation settings as follows: S/T mode, RR12 bpm, Pressure support (PS) was set at 6 cmH2O, and then progressively modified, according to tidal volume (Vte/kg of PBW), in order to target a Vte/kg of 6 ~8 mL/kg PBW and a spontaneous RR lower than 24 breaths/min, FiO2 was increased to target a SpO2 =90%; The oronasal facemask was finely adjusted to target a leak flow lower than 20 L/min. The inspiratory trigger was set at medium and respiratory cycling was set at medium of the inspiratory peak flow. 2. A multifunctional nasogastric tube was placed, and then EIT was connected. Once the patient was used to the experimental setting and appeared to be relaxed, measurements were performed: PEEP titration was initially set at 4 cmH2O(because that the lowest PEEP of NIV is currently 4 cmH2O), and subsequently increased by 1 cm H2O every 10 minutes, until to EIT showed that EELI was significantly elevated. All measurements were performed during a relatively stable spontaneous breathing pattern of 10 minutes and results were averaged for each assessment step. 3. Data recording 3.1. Esophageal pressure measurements: The ?Pes, PEEPi,dyn, PEEPtot, trigger delay, asynchrony index measured by esophageal pressure during PEEP titration were recorded offline. 3.2. EIT measurements: ?EELI. The value of ?EELI was the average of the change in EELI for any 10 breaths per PEEP (compared with PEEP 4cmH2O). We defined the optimal PEEP as “The PEEPtot curves traced during PEEP titration were recorded offline, and the inflection point before the steep rise of the curve was selected as the best PEEP point; if not, 4cmH2O was selected as the optimal PEEP. ” We observed the performance of PEEPi,dyn, ?Pes, trigger delay, asynchrony index, and ?EELI at optimal PEEP. Invasive mechanical ventilation group: 1. Spontaneous breathing phase the patients were ventilated at supine position with mechanical ventilation setti	—

Measure

Time frame

In NIV group 1. The patients were ventilated at supine position with mechanical ventilation settings as follows: S/T mode, RR12 bpm, Pressure support (PS) was set at 6 cmH2O, and then progressively modified, according to tidal volume (Vte/kg of PBW), in order to target a Vte/kg of 6 ~8 mL/kg PBW and a spontaneous RR lower than 24 breaths/min, FiO2 was increased to target a SpO2 =90%; The oronasal facemask was finely adjusted to target a leak flow lower than 20 L/min. The inspiratory trigger was set at medium and respiratory cycling was set at medium of the inspiratory peak flow. 2. A multifunctional nasogastric tube was placed, and then EIT was connected. Once the patient was used to the experimental setting and appeared to be relaxed, measurements were performed: PEEP titration was initially set at 4 cmH2O(because that the lowest PEEP of NIV is currently 4 cmH2O), and subsequently increased by 1 cm H2O every 10 minutes, until to EIT showed that EELI was significantly elevated. All measurements were performed during a relatively stable spontaneous breathing pattern of 10 minutes and results were averaged for each assessment step. 3. Data recording 3.1. Esophageal pressure measurements: The ?Pes, PEEPi,dyn, PEEPtot, trigger delay, asynchrony index measured by esophageal pressure during PEEP titration were recorded offline. 3.2. EIT measurements: ?EELI. The value of ?EELI was the average of the change in EELI for any 10 breaths per PEEP (compared with PEEP 4cmH2O). We defined the optimal PEEP as “The PEEPtot curves traced during PEEP titration were recorded offline, and the inflection point before the steep rise of the curve was selected as the best PEEP point; if not, 4cmH2O was selected as the optimal PEEP. ” We observed the performance of PEEPi,dyn, ?Pes, trigger delay, asynchrony index, and ?EELI at optimal PEEP. Invasive mechanical ventilation group: 1. Spontaneous breathing phase the patients were ventilated at supine position with mechanical ventilation setti

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Secondary

Measure	Time frame
There are no secondary outcome measures	—

Countries

China

Contacts

Public ContactHuiqing Ge

gehq@zju.edu.cn+86 135 8870 6787

Outcome results

None listed

Source: ISRCTN (via WHO ICTRP) · Data processed: Feb 4, 2026