Acute Respiratory Distress Syndrome
Conditions
Keywords
Ventilation Induced Lung Injury, lung overdistension, lung collapse, Electrical Impedance Tomography, Pressure Volume curve, Prone Position
Brief summary
Mechanical ventilation in ARDS requires protective ventilation with low VT and PEEP. PEEP titration can improve lung recruitment in the dependent lung but with a risk of overdistension in the non-dependant lung. EIT can measure the distribution of tidal ventilation and assess overdistension and collapse during a PEEP titration in any position (prone or not). This study aims to measure the best PEEP as a compromise between recruitment and overdistension during a PEEP trial with EIT before and just after PP.
Interventions
OTHERAcute Respiratory Distress Syndrom (ARDS) treated with Prone Position (PP) equipped with Electrical Impedance Tomography (EIT)
Positive End-Expiratory Pressure (PEEP) will be titrated with PEEP-EIT method as it is already done in usual care. A classical low flow Pression Volume (PV) curve will be done in order to detect airway closure and measure compliance, the acquisition of EIT data during PV curve will be analysed secondary with a dedicated software. Reconstruction of EIT derived PV curve will determine the regional airway opening pressures and compliances of the 2 lungs. Two decremental PEEP-EIT titrations will be compared, one in supine and the other just after turning in prone.
Sponsors
University Hospital, Bordeaux
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients hospitalized in the ICU and who suffered moderate or severe ARDS (Berlin criteria, PaO2/FiO2\<150), intubated sedated, under myorelaxant and equipped with EIT * Over the age of 18.
Exclusion criteria
* Broncho-pleural leaks * Pregnant or breastfeeding woman. * Guardianship or curatorship * Deprived of liberty * No health insurance * Impossibility to correctly position the EIT belt (e.g., dressings, chest drainage, etc.) * Contra indications to EIT (e.g., implantable cardiac defibrillator, pacemaker, instable spinal lesions)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Level of distension | 48 hours after inclusion day | Assessing the level of distension when titrating the optimal PEEP in the supine position (SP) and in the PP position the first and second day of ARDS in PP. The measure will be obtained thanks to the crossing in EIT of the overdistension curve and the collapse curve when the PEEP is reduced from 20 to 5 cmH2O. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of the percent of overdistension and collapse during the EIT-PEEP titration | 48 hours after inclusion day | Thanks to PEEP-EIT titration in PP and SP the percent of collapse and global over-distension in EIT will be evaluate. |
| Repartition of regional ventilation in each part of the lungs. | 48 hours after inclusion day | Thanks to PV-EIT curve, the measurement of regional Airway Opening Pressure (anterior vs posterior) will be evaluate (lower inflection point of the PV-EIT curve). |
Countries
France
Contacts
Primary ContactBenjamin REPUSSEAU, Dr
Outcome results
None listed