Ards
Conditions
Keywords
ARDS（Acute respiratory syndrome）;, stress;, strain;, Trans-pulmonary pressure;, FRC(functional residual capacity ), PEEP（post end-expiratory pressure）;, EIT（Electronic impedance tomography）;, RVD(region ventilation delay)
Brief summary
This study try to use EIT ( Electronic impedance tomography ) to evaluate the alveolar heterogeneity and use trans-pulmonary pressure and stain to evaluate the lung injury . The study use these methods to figure out how PEEP impact the alveolar heterogeneity and VILI.
Detailed description
ARDS(Acute respiratory distress syndrome )is common in patients suffering Sepsis, trauma, burning and other sever condition and characterized by diffuse alveolar damage and alveolar heterogeneity.ARDS patient need MV(mechanical ventilation )to maintain oxygenation and need unique MV tragedy to avoid VILI(Ventilator induced Lung injury ).PEEP(post-end-expiratory pressure) is crucial to maintain oxygenation and avoid VILI according to researches. But there are also some other research different voice. This study try to use EIT ( Electronic impedance tomography ) to evaluate the alveolar heterogeneity and use trans-pulmonary pressure and stain to evaluate the lung injury . The study use these methods to figure out how PEEP impact the alveolar heterogeneity and VILI.
Interventions
DEVICEPost-end-Expiratory pressure
Titrate the PEEP from 24 cmH2O to 6 cmH2O, 2 cmH2O/step and record EIT, trans-pulmonary pressure, hemodynamic parameter and Blood-gas analysis.
Sponsors
Southeast University, China
Study design
Observational model
CASE_CROSSOVER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Age≥18 or\<80； 2. Moderate or sever ARDS in 2012 \<Berlin definition\>; 3. Applied mechanical ventilation; 4. Consent signed.
Exclusion criteria
1. Asthma or COPD； 2. Cardiogenic edema； 3. Sever neutropenia(\<500/mm3)； 4. Hemodynamic astatic: DOPA or Dobutamine \>15 µg/kg/ min; NE \> 15ug /min； 5. GCS coma score ≤12； 6. Thoracic injury or surgery patients contradict EIT ； 7. Refuse to join in trail； 8. Included in other clinical trail。
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PaCO2 | September,1,2018-December 30, 2020 | The researchers use blood gas analysis to measure PaCO2( arterial carbon dioxide pressure,mmHg) . |
| tidal volume | September,1,2018-December 30, 2020 | The researchers use ventilator to measure tidal volume(ml) in patients with mechanical ventilation and without spontaneous breathing.. |
| respiratory rate | September,1,2018-December 30, 2020 | The researchers record the set respiratory rate(bpm) in patients with mechanical ventilation. |
| flow | September,1,2018-December 30, 2020 | The researchers record the set Flow (L/min) in patients with mechanical ventilation. |
| FiO2 | September,1,2018-December 30, 2020 | The researchers record the set FiO2 ( fraction of inspiratory oxygen, %) in patients with mechanical ventilation. |
| PaO2 | September,1,2018-December 30, 2020 | The researchers use blood gas analysis to measure PaO2( arterial oxygen pressure,mmHg) |
| alveolar hyper-distention; alveolar collapse；alveolar opening and closing； | September,1,2018-December 30, 2020 | The study use Pulmo Vista 500 device (Drager co.),is intended to perform thoracic bioimpedance measurements by applying the technique of electrical impedance tomography (EIT)to evaluate alveolar hyper-distention(%of the lung volume); alveolar collapse(% of the lung volume)；alveolar opening and closing(% of the lung volume). |
| Trans-pulmonary pressure | September,1,2018-December 30, 2020 | The researchers place tube in the esophagus and connect it to transmitter to measure esophageal pressure (mmHg)and calculate trans-pulmonary pressure(mmHg) to evaluate stress |
| EELV | September,1,2018-December 30, 2020 | The research use nitrogen wash out to measure EELV（end-expiratory lung volume, ml） to calculate dynamic strain and evaluate the strain |
| peak pressure | September,1,2018-December 30, 2020 | The researchers use ventilator to measure peak pressure(cmH2O) in patients with mechanical ventilation and without spontaneous breathing.. |
| plateau pressure | September,1,2018-December 30, 2020 | The researchers use ventilator to do inspiration pause to measure plateau pressure(cmH2O) in patients with mechanical ventilation and without spontaneous breathing. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| DBP | September,1,2018-December 30, 2020 | Recording DBP(Diastolic pressure, mmHg),which is always continuously monitored with invasive pressure monitor. |
| CVP | September,1,2018-December 30, 2020 | Recording CVP(central venous Pressure）,which is always discontinuously monitored with jugular pressure monitor mmHg). |
| vasopressor | September,1,2018-December 30, 2020 | Recording clinical vasopressor usage including Norepinephrine（ μg/Kg/min;）Epinephrine（μg/Kg/min） Dobutamine （ μg/Kg/min) |
| SBP | September,1,2018-December 30, 2020 | Recording SBP(systolic pressure, mmHg),which is always continuously monitored with invasive pressure monitor. |
Countries
China
Contacts
Primary Contactling Liu, Phd
Backup Contacthaibo qiu, PhD
Outcome results
None listed