Acute Kidney Injury, Acute Respiratory Distress Syndrome, Intra-Abdominal Hypertension, Prone Position
Conditions
Brief summary
Patients suffering from Acute Respiratory Distress Syndrome (ARDS) with a prone position (PP) indication will benefit from measurements of renal resistive index, intra-abdominal pressure (IAP), urinary oxygen tension (uPO2) and ventilatory mechanics in supine position (baseline IAP), after 2 hours in PP at the current IAP value, thirty minutes after patients' abdomen suspension in order to resume baseline IAP and after patients' are turned back to supine position.
Interventions
OTHERProne position
Abdomen suspension in prone position
Sponsors
French Society for Intensive Care
Act For Chronic Diseases
University Hospital, Grenoble
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ARDS patients according to Berlin criteria, intubated, mechanically ventilated * with PaO₂/FiO₂ \< 150 mmHg, * neuromuscular blockade * with an indication of PP done by the physician in charge * possibility to differ PP for one hour * patients should be hemodynamically stable since at least 4 hours
Exclusion criteria
* Pregnant or breast-feeding women * legal protection, no social security affiliation * PP contra-indication * nasogastric tube contra-indication * extra corporeal membrane oxygenation * acute kidney injury at inclusion according to K-DIO criteria, chronic kidney disease defined as an estimated glomerualr filtration rate less than 30 ml/min/1.73m², kidney transplantation, renal artery stenosis, solitary kidney, albuminuria \> 1.25 mg/ml * cardiac arrhythmia * obesity * advanced cirrhosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change in renal resistive index (RRI) | At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver | RRI measurement will be performed on a right kidney arcuate/interlobar artery, with a high frequency Doppler probe. Three to five consecutive measures will be obtained then RRI computed according to the formula: (peak systolic velocity - end diastolic velocity)/peak systolic velocity). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ventilatory mechanics: transpulmonary pressure | At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver | transpulmonary pressure will be measured at the end of inspiration and expiration and continuously recorded on a datalogger |
| ventilatory mechanics: driving pressure | At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver | driving pressure will be measured at the end of inspiration and expiration and continuously recorded on a datalogger |
| ventilatory mechanics: elastance | At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver | elastance will be measured at the end of inspiration and expiration and continuously recorded on a datalogger |
| haematosis | At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver | arterial oxygen tension (PaO2) and arterial dioxide carbon tension (PaC02) |
| Intra abdominal pressure | At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver and two hours after patients are back in supine position | Intra abdominal pressure will be measured thanks to a dedicated nasogastric tube with two balloons (gastric pressure) |
| Persisting effect of IAP increase in prone position when patients are back in supine position on renal resistive index | Two hours after patients are back in supine position | RRI measurement will be performed on a right kidney arcuate/interlobar artery, with a high frequency Doppler probe. Three to five consecutive measures will be obtained then RRI computed according to the formula: (peak systolic velocity - end diastolic velocity)/peak systolic velocity). |
| change in renal medullary oxygen tension | At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver | urinary oxygen tension (uPO₂) will be measured via a fiber-optic luminescence optode inserted through the bladder catheter lumen |
| Persisting effect of IAP increase in prone position when patients are back in supine position on ventilatory mechanics: transpulmonary pressure | Two hours after patients are back in supine position | transpulmonary pressure will be measured at the end of inspiration and expiration and continuously recorded on a datalogger |
| Persisting effect of IAP increase in prone position when patients are back in supine position on ventilatory mechanics: driving pressure | Two hours after patients are back in supine position | driving pressure will be measured at the end of inspiration and expiration and continuously recorded on a datalogger |
| Persisting effect of IAP increase in prone position when patients are back in supine position on ventilatory mechanics: elastance | Two hours after patients are back in supine position | elastance will be measured at the end of inspiration and expiration and continuously recorded on a datalogger |
| Persisting effect of IAP increase in prone position when patients are back in supine position on haematosis | Two hours after patients are back in supine position | arterial oxygen tension (PaO2) and arterial dioxide carbon tension (PaC02) |
| Acute kidney injury | within 48 hours following prone position | According to creatinine or diuresis criteria of Kidney Disease: Improving Global Outcomes (K-DIGO) classification |
| Persisting effect of IAP increase in prone position when patients are back in supine position on urinary PO2 | Two hours after patients are back in supine position | urinary oxygen tension (uPO₂) will be measured via a fiber-optic luminescence optode inserted through the bladder catheter lumen |
Countries
France
Outcome results
None listed