Acute Respiratory Distress Syndrome
Conditions
Keywords
acute respiratory distress syndrome, prone position, electrical impedance tomography, mechanical ventilation
Brief summary
Acute Respiratory Distress Syndrome (ARDS) is a syndrome characterized by respiratory distress and refractory hypoxemia caused by pulmonary and extra-pulmonary factors. Despite improvements in diagnosis and treatment in recent years, the mortality rate of severe ARDS is still around 40%. The distribution of lung lesions in ARDS patients is significantly gravity-dependent. Even with lung-protective ventilation strategies, tidal volume is concentrated in the ventral lung region, leading to ventilator-associated lung injury. Prone position ventilation can increase ventilation to the dorsal lung tissue and improve the ventilation-perfusion ratio, thus improving oxygenation. During prone position ventilation in ARDS patients, lung-protective ventilation strategies should be maintained, but with different respiratory mechanics from the supine position, requiring adjustment of ventilator parameters. Electrical Impedance Tomography (EIT) technology can be used for bedside monitoring of mechanically ventilated patients, providing real-time feedback on the patient's ventilation status and having great potential for clinical applications. Investigators believes that EIT monitoring during prone position ventilation in ARDS patients can individualize lung-protective ventilation strategies, minimize alveolar overdistension and collapse, improve the weaning success rate of invasive ventilation, and ultimately improve patient prognosis.
Interventions
PROCEDUREEIT-guided mechanical ventilation strategy
During prone ventilation, the PEEP level is adjusted based on EIT monitoring. The optimal PEEP is the lowest sum of collapse and overdistension percentages
PROCEDURELung protective ventilation group
Lung-protective ventilation strategy during prone positioning that continues the supine position.
Sponsors
Beijing Chao Yang Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 18 years old； 2. Meets the diagnostic criteria for ARDS according to the 2012 Berlin definition； 3. Intubation with invasive mechanical ventilation time \< 36 hours； 4. PaO2/FiO2 \< 150mmHg.
Exclusion criteria
1. Contraindication to the prone position; 2. Contraindication to the EIT; 3. Patients have received extracorporeal membrane oxygenation treatment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 28-day weaning rate from invasive mechanical ventilation | At 28 days of hospitalization. | After weaning from invasive mechanical ventilation lasting more than 48 hours, continuation with either high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV). |
Countries
China
Contacts
Primary ContactYu Zhao, Dr.
Outcome results
None listed