Acute Respiratory Failure
Conditions
Keywords
Acute respiratory failure, diaphragm, dyspnea, EIT
Brief summary
Modern management of acute respiratory failure aims to relieve dyspnea and anxiety by providing a non-invasive respiratory support. This approach tries to avoid endotracheal intubation, patient self inflicted lung injuries (PSILI) and diaphragmatic dysfunction. The present study aims to evaluate dyspnea, pulmonary regional ventilation and diaphragmatic function in patients with hypoxemic acute respiratory failure by different observations, and to bring risk factor for intubation out.
Detailed description
Patients aged of 18 years or more, presenting with an acute respiratory failure without hypercapnia will be included in the study. Clinical and biological variables, dyspnea assessment, regional lung ventilation (electrical impedance tomography) and diaphragm function (ultrasound) will be evaluated at inclusion and at 2 hours, 4 hours and 48 hours after inclusion. In case of intubation, diaphragmatic function will be also evaluated with phrenic nerve stimulation technique. Primary endpoint is intubation at day 7. Secondary endpoints are measurement of dyspnea, pulmonary ventilation and diaphragmatic function, also ventilator free days, ICU length of stay and mortality.
Interventions
OTHERDiaphragmatic ultrasound and electrical impedance tomography
A diaphragmatic ultrasound in a half sitting position. The diaphragmatic excursion and the thickening fraction of the right hemi-diaphragm will be measured. \- Acquisition of 10 minutes of regional pulmonary ventilation by electrical impedance tomography.
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* Age \> 18 * Acute respiratory insufficiency defined by the three following items : 1. PaO2/ FiO2 \<300 2. Respiratory rate \> 25/min 3. Oxygen support \> 10L/min or High Flow nasal oxygen (HFNO) * Non opposition by the patient to be included * Social insurance
Exclusion criteria
* Respiratory acidosis (pH \< 7,35 PaCO2 \> 45mmHg or 6kPa) * Chronic respiratory disease ( COPD, bronchiectasis…) * Cardiogenic Acute lung oedema * Non intubation decision at randomisation * Contraindication for Electro-impedance tomography-belt placement (chest trauma with rib fractures, thoracic wound, chest tube). * Uncommunicative patient (Glasgow coma scale \<12) * Guardianship or curators for vulnerable patients.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Oro-tracheal intubation | 7 days after admission in the ICU | Patients who will be intubated within the 7 days after admission in the ICU |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diaphragmatic function | 2 days after inclusion | using ultrasonography, measure of diaphragmatic excursion and diaphragmatic thickening in Hertz (Hz) |
| lung regional ventilation | 2 days after inclusion | As measured with Electric Impedance Tomography index measures (inhomogeneity index, end expiratory lung impedance change) |
| Dyspnea evaluation | 28 days after inclusion | Dyspnea evaluation using visual analogue scale applied to dyspnea: from 1 to 10, 1 corresponding to "no breathlessness" and 10 to "maximum breathlessness". |
| Mechanical ventilation duration | 28 days after inclusion | (only for intubated patients). |
| ICU length of stay | 28 days after inclusion | for all patients |
| ICU mortality | 28 days after inclusion | for all patients |
Countries
France
Contacts
STUDY_DIRECTORMartin DRES, MD PhD
Assistance Publique - Hôpitaux de Paris
Outcome results
None listed