ARDS (Acute Respiratory Distress Syndrome)
Conditions
Keywords
EIT, ARDS, PEEP
Brief summary
Patients with acute respiratory distress syndrome are placed on mechanical ventilation, and the adjustment of ventilator parameters is an important step in their care, in particular positive expiratory pressure, applied at the end of breathing. The goal of this study is to learn if continuous anterior chest compression works as well as electrical impedance tomography for positive expiratory pressure titration. Researchers will compare the two methods for each patient, in a randomly determined order : continuous anterior chest compression and electrical impedance tomography. Participants will : * have a pep titration with both techniques * be included in the study for 28 days
Detailed description
Personalizing the PEEP level is an important step in ventilator adjustment in ARDS patients. The investigators have developed a simple, low-cost method to detect overdistension of the lung, consisting of applying manual compression to the anterior aspect of the patient's thorax, and observing whether the ventilator pressure increases or decreases. The investigators hypothesize that with this simple method it is possible to determine the PEEP level which corresponds to that determined with EIT.
Interventions
OTHERPEEP titrations
Assessment of ideal PEEP using electrical impedance tomography will be performed. The evaluation of PEEP using the thorax compression maneuver method will be carried out. A blood sample (the "blood gases") will be taken at the ideal PEEP determined by electrical impedance tomography and at the ideal PEEP determined by the manual chest compression maneuver.
Sponsors
Centre Hospitalier Saint Joseph Saint Luc de Lyon
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
Assessment of ideal PEEP using electrical impedance tomography will be performed as part of usual care but recorded for research purposes. The evaluation of PEEP using the thorax compression maneuver method will be carried out. A blood sample (the "blood gases") will be taken at the ideal PEEP determined by electrical impedance tomography and at the ideal PEEP determined by the manual chest compression maneuver. All of these evaluations will not exceed three hours. Then, usual care will be continued and no further interventions will be carried out as part of the research. The patient will remain included in the study for 28 days in order to collect their health status on the 28th day.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Moderate to severe ARDS according to the Berlin criteria * Patient receiving sedation and continuous curarization * Free and informed consent from the patient or their loved one
Exclusion criteria
* ECMO * Pneumothorax * Chest trauma in the last 3 months * Uncontrolled shock (noradrenaline \> 5 mg/h) * Pregnant or breastfeeding woman * Protected adult within the meaning of the law * Lack of social security * Patient under AME
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PEPCTAC | Day 0 | PEPCTAC (unit : cmH2O) |
| PEPCAC | Day 0 | PEPCAC (unit : cmH2O) |
| PEPEIT | Day 0 | PEPEIT (unit : cmH2O) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of collapse at PEPCTAC | Day 0 | Percentage of collapse at PEPCTAC |
| Percentage of collapse at PEPCAC | Day 0 | Percentage of collapse PEPCAC |
| Percentage of collapse at PEPEIT | Day 0 | Percentage of collapse at PEPEIT |
| Compare respiratory mechanics for PEPCTAC and PEPCAC and PEPEIT | Day 0 | Respiratory mechanics at PEPCTAC and PEPCAC ans PEPEIT : peak and plateau pressure, driving pressure, respiratory system compliance, pulmonary and parietal compliance, respiratory system resistance, end-expiratory transpulmonary pressure, stress index at each PEEP level |
| Compare PEPCTAC and other PEEP adjustment methods reported in the literature | Day 0 | Comparison of the PEPCTAC level to the PEP level according to the maximum recruitment arm of the Express study (PEP level which is accompanied by a Pplat between 28 and 30 cm H2O), Comparison of the PEPCTAC level to the PEP level according to the PEP/FiO2 scales, Comparison of the PEPCTAC level to the minimum PEEP level to obtain a positive end-expiratory transpulmonary pressure |
| Evaluate the effect of CTAC on plateau pressure based on levels of distension and collapse resulting from PEEP | Day 0 | • Correlation between variation of plateau pressure with CTAC and percentage of distension linked to PEEP |
| Evaluate the effect of CTAC on plateau pressure based on levels of collapse resulting from PEEP | Day 0 | • Correlation between variation of plateau pressure with CTAC and percentage of collapsus linked to PEEP |
| Evaluate the effect of CTAC on plateau pressure based on the distribution of ventilation between dependent and non-dependent zones resulting from PEEP | Day 0 | Correlation between variation of plateau pressure with CTAC and percentage of anterior ventilation |
| Evaluate the effects of CTAC on regional compliance according to the level of PEP | Day 0 | Regional compliances (four areas of interest with antero-posterior distribution) of the respiratory and pulmonary system estimated using EIT, airway pressure and esophageal pressure |
| Evaluate the effect of recruitability potential on the level of PEPCTAC and PEPEIT | Day 0 | R/I ratio |
| Evaluate the effect of airway opening pressure on the level of PEPCTAC and PEPEIT | Day 0 | Evaluation of the airway opening pressure by performing a slow flow pressure-volume curve (quasi-static condition) from a PEEP set at zero cm H2O |
| Evaluate the effects of PEEP on right ventricular function | Day 0 | Right ventricular function assessed by echocardiography: mitral inflow, subaortic VTI, subpulmonary VTI, continuous-wave pulmonary Doppler and assessment of pulmonary regurgitation, continuous Doppler, TAPSE (tricuspid annular plane systolic excursion), tricuspid annular S-wave. Presence of acute cor pulmonale defined by an RV/LV ratio \> 0.6 associated with paradoxical septal motion, PAPi (pulmonary artery pulsatility index). Septal and free-wall right ventricular strains. |
| Evaluate the effect of PEEP on venous congestion | Day 0 | Venous congestion assessed by ultrasound (VExUS score) |
| Compare the percentages of distension between PEPCTAC and PEPCAC and PEPEIT | Day 0 | Percentages of distension between PEPCTAC and PEPCAC and PEPEIT |
Countries
France
Contacts
CONTACTEmmanuel Vivier, MD
CONTACTFanny Doroszewski, Mrs
Outcome results
None listed