Severe ARDS
Conditions
Keywords
ECMO, ARDS, ultra-protective mechanical ventilation
Brief summary
For ECMO supported patients with severe ARDS (acute respiratory distress syndrome), usual care include use of ultraprotective mechanical ventilation with tidal volume and pressure reductions that might ultimately enhance lung protection of patients with ARDS. Although very low tidal might also cause pulmonary derecruitment. The aim of this study is to monitor effects of very low tidal volume on regression of overdistension and derecruitment using electrical impedance tomography. Secondary aim is to describe the evolution of the optimal PEEP (Positive End Expiratory Pressure) during the decrease of the tidal volume
Detailed description
Patients requiring venovenous ECMO support for severe ARDS will be monitored with electrical impedance tomography during introduction of ultraprotective mechanical ventilation. Monitoring will start with pre-ECMO ventilator setting, then the tidal volume will be lowered step by step. Other parameters of the ventilator will be kept constant. Then, cumulated collapse and overdistention percentages will be estimated for each tidal volume. Optimal tidal volume will be defined by the lowest sum of alveolar overdistension and collapse. Also, at the end of each step, PEEP titration will be performed to identify the optimal PEEP setting that combines the best alveolar recruitment with minimal overdistention. The aim is to determine whether the derecruitment induced by the decrease in tidal volume can be reduced by the application of PEP. Then, comparison of the different tidal volumes with application of ideal PEEP will be performed: measurement of the percentage of collapsed and overdistended areas by impedancemetry method between the different levels of tidal volume with application of ideal PEEP.
Interventions
DEVICEUltra-protective mechanical ventilation monitored by electrical impedance tomography
A silicone EIT belt will be placed around the patient's thorax (sixth intercostal parasternal space). EIT data will be generated by application of a small alternating electrical current (5 mA at 50 kHz). Introduction of ultraprotective mechanical ventilation will be monitored.
Sponsors
Assistance Publique - Hôpitaux de Paris
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
* aged ≥ 18 years * patient with ARDS on venovenous (VV)-ECMO * Written informed consent * patient affiliated to a social security scheme
Exclusion criteria
* Pregnancy * Adult patient subject to a legal protection measure (tutor, curator, etc.) * Patients with a pacemaker, automatic implantable cardioverter defibrillator, * contraindications to thoracic belt placement (e.g., thoracic or spinal cord trauma, recent thoracic surgery) * undrained pneumothorax, bronchopleural fistula * hemodynamic instability (i.e., use of intravenous fluids of more than 10 mL/kg or vasopressors 2 mg/h of norepinephrine or 0.5 mg/h of epinephrine)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| cumulated collapse and overdistention percentages for each tidal volume by impedancemetry method | One day | Estimating the best lung-compartment compliance, reflected by the number of functional lung units in that region, and current compliance for each pixel, the collapse and overdistention percentages per pixel will be compared for each tidal volume, with constant (pre-ECMO) PEEP. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Optimal PEEP by impedancemetry method at each tidal volume | One day | PEEP titration will be performed to identify the optimal PEEP setting that combines the best alveolar recruitment with minimal overdistention at each tidal volume |
| cumulated collapsed and overdistended for each tidal volume by impedancemetry method with application of optimal PEEP | One day | Estimating the best lung-compartment compliance, reflected by the number of functional lung units in that region, and current compliance for each pixel, the collapse and overdistention percentages per pixel will be compared for each tidal volume, with optimal PEEP |
Countries
France
Contacts
Primary ContactMatthieu Pr SCHMIDT
Outcome results
None listed