ARDS, Human
Conditions
Brief summary
Acute respiratory syndrome distress (ARDS) is a clinical common syndrome with high mortality. Mechanical ventilation (MV) is the cornerstone of management of ARDS but can lead to ventilator-induced lung injury. Positive end-expiratory pressure (PEEP), as one of main component of MV, has been widely used in the clinical practice. However, how to best set PEEP is still a difficult problem for moderate to severe ARDS patients. EIT, an imaging tool evaluating the regional ventilation distribution at the bedside, can achieve the individual PEEP selection for all mechanically ventilated patients. This article compared the effect of PEEP titrated guided by EIT with fraction of inspired oxygen (FiO2)-PEEP table on the ventilation-perfusion mismatch.
Interventions
DEVICEPEEP selection
Electric impedance tomography-guided PEEP titration
Sponsors
Southeast University, China
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Intubated patients with moderate and severe ARDS (Berlin definition, PaO2/FiO2 ≤200 mmHg at PEEP 5 cmH2O) 2. undergoing deep sedation on controlled mechanical ventilation within72 hours after ARDS onset
Exclusion criteria
1. age \<18 years old 2. patient undergoing legal protection 3. contra-indications to EIT (e. g. severe chest trauma or wounds) 4. pneumothorax 5. patient undergoing ECMO 6. pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference in ventilation-perfusion mismatch between EIT-PEEP, low-PEEP, and high PEEP | up to 24 hours | EIT-PEEP was obtained by EIT, low-PEEP was obtained by low FIO2-PEEP table, and high-PEEP was obtained by high FIO2-PEEP table. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference in dead space measured with EIT between EIT-PEEP, low-PEEP, and high PEEP | up to 24 hours | dead space was obtained by EIT monitoring |
| Difference in shunt measured with EIT between EIT-PEEP, low-PEEP, and high PEEP | up to 24 hours | shunt was obtained by EIT monitoring |
| Difference in wasted ventilation measured with EIT between EIT-PEEP, low-PEEP, and high PEEP | up to 24 hours | wasted ventilation was obtained by EIT monitoring |
| Difference in wasted perfusion measured with EIT between EIT-PEEP, low-PEEP, and high PEEP | up to 24 hours | wasted perfusion was obtained by EIT monitoring |
| ventilation distribution measured with EIT between EIT-PEEP, low-PEEP, and high PEEP | up to 24 hours | ventilation distribution was obtained by EIT in difference regions |
| difference in center of ventilation (COV) between EIT-PEEP, low-PEEP, and high PEEP | up to 24 hours | COV was obtained by EIT monitoring |
| Correlations between ventilation-perfusion mismatch and overdistension and lung collapses | up to 24 hours | Overdistension (%) and lung collapses (%) will be assessed by EIT. These two values cannot be measured separately. V/Q mismatch will be computed by EIT, and expressed in %. Correlation will be performed by linear regression. |
| recruitment-to-inflation (R/I) ratio | up to 24 hours | recruitment-to-inflation (R/I) ratio was computed between the two PEEP levels |
| PaO2/FIO2 | up to 24 hours | PaO2/FIO2 was obtained by gas analysis |
| respiratory system mechanics | up to 24 hours | respiratory system compliance included lung compliance, chest wall compliance, and respiratory system compliance. respiratory system resistance will be computed as the inverse of compliance. |
| Correlation between V/Q mismatch markers and recruitability | up to 24 hours | Recruitability will be assessed between 15 and 5 cmH2O by respiratory mechanics, as the recruited volumes value (in mL). R/I ratio will be derived from these data (no unit). V/Q mismatch will be computed by EIT, and expressed in %. Correlation will be performed by linear regression. |
| perfusion distribution measured with EIT between EIT-PEEP, low-PEEP, and high PEEP | up to 24 hours | perfusion distribution was obtained by EIT in difference regions |
Countries
China
Outcome results
None listed