Acute Respiratory Distress Syndrome, Prone Position
Conditions
Brief summary
The prone maneuver is a well-established therapy in ARDS. Traditionally, the maneuver is perform with thoraco-abdominal cushions. The goal of this study is assess, using electrical impedance tomography, whether the arrangement mode of the cushions alters lung recruitment during the prone maneuver in patients with moderate to severe ARDS.
Detailed description
The prone position is a ventilatory therapeutic strategy used in the treatment of patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS) that promotes improved oxygenation with consequent reduction in mortality. Despite being safe and effective, it is not without complications, with pressure injuries being one of the main concerns. The use of cushions helps prevent such injuries, but they can interfere with ventilatory mechanics depending on where they are placed. The aim of this study is to assess whether there is a difference in ventilatory mechanics when performing the prone maneuver with a thoraco-abdominal cushion or a modified lateral cushion, based on measurements from electrical impedance tomography (EIT), gasometric data, and parameters of mechanical ventilation.
Interventions
PROCEDUREProne position with thoraco-abdominal cushion
Prone position with cushions positioned laterally on the chest, abdomen, and pelvis
Sponsors
Hospital de Clinicas de Porto Alegre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients aged 18 years or more, with * moderate or severe acute respiratory distress syndrome (ARDS), and * indication of prone position
Exclusion criteria
* Contra-indication to the prone position: intracranial pressure \> 30 mmHg or cerebral perfusion pressure \< 60 mmHg; massive haemoptysis needing urgent surgical or radiological treatment; tracheal or thoracic surgery in the last 15 days; facial trauma or surgery in the last 15 days; deep venous thrombosis or pulmonary embolism treated in the last 2 days; unstable bone dislocations of rachis, femur, rib cage, pelvis; mean systolic arterial pressure less than 70 mmHg despite vasopressive therapy and pregnancy * Severe acute respiratory distress syndrome (ARDS) caused b coronavirus disease 2019 (despite meeting the Berlin criteria for ARDS, their ventilatory mechanics are characterized by nearly normal compliance, something rarely seen in patients with ARDS from other etiologies) * contraindications for the use of Electrical Impedance Tomography (EIT) such as presence of a cardiac implantable electronic device * Pulmonary transplantation * Prone position before enrollment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Lung recruitment | 1 hour before prone - 2 hours before supine | Change in ventilation of dorsal regions of lung (%) assessed by electrical impedance tomography |
Countries
Brazil
Contacts
Primary ContactVanessa Martins de de Oliveira
Backup ContactMariana Berger do Rosário
Outcome results
None listed