ARDS
Conditions
Keywords
ARDS, TCAV, EIT, APRV
Brief summary
Acute respiratory distress syndrome (ARDS) is a severe form of acute respiratory failure. The therapeutic management is currently based on the treatment of the cause of ARDS, and on mechanical ventilation with positive expiratory pressure (PEEP). Another strategy that could be used is Time Controlled Adaptive Ventilation (TCAV) method based on ventilation using the airway pressure release ventilation (APRV) mode. Electrical impedance tomography (EIT) allows individual, non-invasive, real-time, bedside, radiation-free imaging of an anteroposterior section of the right and left lungs, with global and regional dynamic analyses. The aim of the study is to evaluate EIT for PHigh titration of TCAV.
Detailed description
Acute respiratory distress syndrome (ARDS) is a severe form of acute respiratory failure with a mortality rate of up to 35% for the most severe forms. The therapeutic management is currently based on the treatment of the cause of ARDS, and on mechanical ventilation with positive expiratory pressure (PEEP). Another strategy that could be used is Time Controlled Adaptive Ventilation (TCAV) method based on ventilation using the airway pressure release ventilation (APRV) mode. The TCAV method is based on a prolonged THigh set at a constant pressure, creating a continuous positive pressure phase associated with a brief release during a TLow allowing the elimination of carbon dioxide and the creation of an intrinsic PEEP. With long high pressure phase this method could result in better recruitment but could also expose the patient to overdistention. While the TLow setting is well defined, level of PHigh is not standardized. Electrical impedance tomography (EIT) allows individual, non-invasive, real-time, bedside, radiation-free imaging of an anteroposterior section of the right and left lungs, with global and regional dynamic analyses. Results of recent studies have highlighted the benefits of EIT, especially for ARDS patients in titrating PEEP in volume-controlled ventilation. To date, no published study has evaluated EIT for PHigh titration using the TCAV method in patients with severe ARDS.
Interventions
None listed
Sponsors
Central Hospital, Nancy, France
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Moderate to severe ARDS patients with more than 24 hours of mechanical ventilation * Under sedation with a Richmond Rating Scale less than or equal to -2.
Exclusion criteria
* Patients with a pacemaker or automatic implantable defibrillator * Pregnant women. * Contraindications to chest belt placement (e.g., spinal or thoracic recent surgery) * Undrained pneumothorax, broncho-pleural fistula * Hemodynamic instability (i.e., use of vasopressors at \> 2 ug.kg.min of norepinephrine) * Patients on mechanical ventilation during more than 7 days
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of collapsed units on EIT | through study completion an average of 1 day | Percentage of collapsed lung areas measured at increasing levels of Phigh |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of overdistanded units | through study completion an average of 1 day | Percentage of overdistanded units measured at increasing levels of Phigh |
Countries
France
Contacts
Primary ContactMatthieu KOSZUTSKI, MD
Backup ContactBenjamin PEQUIGNOT, MD
Outcome results
None listed