Acute Chest Syndrome, Sickle Cell Anemia
Conditions
Keywords
Acute Chest Syndrome, Sickle Cell Anemia, Awake Prone Positioning, Electric Impedance
Brief summary
Acute chest syndrome (ACS) is the leading cause of admission to intensive care and the leading cause of death in patients with sickle cell disease. Irrespective of the cause of ACS, there is an heterogeneity in pulmonary ventilation/perfusion ratios, leading to worsening of the disease. Efficiency of awake prone positioning (APP) in acute respiratory failure (ARF) was particularly highlighted during the COVID-19 pandemic. Several physiological factors contribute to this benefit including an improvement in ventilatory drive and gas exchange. The investigator hypothesize that APP could lead to clinical improvement in ACS in terms of oxygenation and ventilatory drive, by improving the heterogeneity of ventilation
Detailed description
* Several physiological mechanisms contribute to the benefit of APP during ARF. In addition to hypoxemia improvement, there is also an effect on ventilatory drive, notably in terms of polypnea, ROX index and inspiratory effort. * Considering that hypoxemia in ACS contributes to the physiopathological process: deoxygenation of haemoglobin S - red blood cells falciformisation - vaso-occlusive event, APP could be an additional therapy in severe ACS. In addition, improving ventilation-perfusion ratios, mainly by recruiting dorsal zones, could be particularly useful in ACS, where pulmonary damage predominates in gravito-dependent zones.
Interventions
PROCEDUREAwake prone positioning (APP)
* APP are realized following the diagnosis of ACS * Prone positioning or supine positioning are performed under supervision of a physician or a nurse * Maximum session duration: 16 hours per day * Sessions of prone positioning can be shortened, if necessary (30 minutes minimum), for better tolerance * Tolerance of prone positioning is assessed by the physician in charge and sessions and may be stopped in case of poor tolerance
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>18 years * Major sickle cell anemia (SS, SC, Sβ) * Admission in intensive care unit for ACS * Registered in the French social insurance regime. * Written, informed consent
Exclusion criteria
* Pregnant or breastfeeding women * Immediate need for intubation * Impaired vigilance status (Glasgow scale score \< 12) * Pneumothorax * Haemodynamically unstable * Thoracic trauma admission * Severely obese with body-mass index higher than 40 kg/m² * EIT contraindication: pacemaker, automatic implantable defibrillators, skin lesions facing the EIT belt, unstable rachis fracture or medullary lesions
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The total duration of APP during the stay in intensive care unit | 28 days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| GI measured by EIT | Up to 28 days | — |
| ΔEELI measured by EIT | Up to 28 days | — |
| Pain measurement assessed by visual analog scale, | Up to 28 days | — |
| Pain measurement assessed by morphine consumption | Up to 28 days | — |
| Changes in respiratory parameters | Up to 28 days | Assessment of respiratory parameters changes |
| Occurrence of skin lesions during the intensive care unit stay | 28 Days | — |
| Occurrence of displacement of devices during the intensive care unit stay | 28 Days | — |
| Occurrence of use of vital support therapy during the intensive care unit stay | 28 Days | — |
| Pain measurement assessed by analgesic therapeutic escalation | Up to 28 days | — |
Countries
France
Contacts
Primary ContactMatthieu Turpin, MD
Backup ContactMuriel Fartoukh, MD, PhD
Outcome results
None listed