Post- End- Expiratory Pressure Affect the Alveolar Heterogeneity in Moderate and Sever ARDS Patients

Southeast University, China40 enrolled

Overview

This study try to use EIT ( Electronic impedance tomography ) to evaluate the alveolar heterogeneity and use trans-pulmonary pressure and stain to evaluate the lung injury . The study use these methods to figure out how PEEP impact the alveolar heterogeneity and VILI.

ARDS(Acute respiratory distress syndrome )is common in patients suffering Sepsis, trauma, burning and other sever condition and characterized by diffuse alveolar damage and alveolar heterogeneity.ARDS patient need MV(mechanical ventilation )to maintain oxygenation and need unique MV tragedy to avoid VILI(Ventilator induced Lung injury ).PEEP(post-end-expiratory pressure) is crucial to maintain oxygenation and avoid VILI according to researches. But there are also some other research different voice. This study try to use EIT ( Electronic impedance tomography ) to evaluate the alveolar heterogeneity and use trans-pulmonary pressure and stain to evaluate the lung injury . The study use these methods to figure out how PEEP impact the alveolar heterogeneity and VILI.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Ards

Interventions

Post-end-Expiratory pressureDEVICE

Titrate the PEEP from 24 cmH2O to 6 cmH2O, 2 cmH2O/step and record EIT, trans-pulmonary pressure, hemodynamic parameter and Blood-gas analysis.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age≥18 or\<80； 2. Moderate or sever ARDS in 2012 \<Berlin definition\>; 3. Applied mechanical ventilation; 4. Consent signed. Exclusion Criteria: 1. Asthma or COPD； 2. Cardiogenic edema； 3. Sever neutropenia(\<500/mm3)； 4. Hemodynamic astatic: DOPA or Dobutamine \>15 µg/kg/ min; NE \> 15ug /min； 5. GCS coma score ≤12； 6. Thoracic injury or surgery patients contradict EIT ； 7. Refuse to join in trail； 8. Included in other clinical trail。

Locations (1)

Nanjing Zhong-Da Hospital

Nanjing, Jiangsu, China

RECRUITING

Outcomes

Primary Outcomes

alveolar hyper-distention; alveolar collapse；alveolar opening and closing；

The study use Pulmo Vista 500 device (Drager co.),is intended to perform thoracic bioimpedance measurements by applying the technique of electrical impedance tomography (EIT)to evaluate alveolar hyper-distention(%of the lung volume); alveolar collapse(% of the lung volume)；alveolar opening and closing(% of the lung volume).

Time frame: September,1,2018-December 30, 2020

Trans-pulmonary pressure

The researchers place tube in the esophagus and connect it to transmitter to measure esophageal pressure (mmHg)and calculate trans-pulmonary pressure(mmHg) to evaluate stress

Time frame: September,1,2018-December 30, 2020

EELV

The research use nitrogen wash out to measure EELV（end-expiratory lung volume, ml） to calculate dynamic strain and evaluate the strain

Time frame: September,1,2018-December 30, 2020

peak pressure

The researchers use ventilator to measure peak pressure(cmH2O) in patients with mechanical ventilation and without spontaneous breathing..

Time frame: September,1,2018-December 30, 2020

plateau pressure

The researchers use ventilator to do inspiration pause to measure plateau pressure(cmH2O) in patients with mechanical ventilation and without spontaneous breathing.

Time frame: September,1,2018-December 30, 2020

tidal volume

The researchers use ventilator to measure tidal volume(ml) in patients with mechanical ventilation and without spontaneous breathing..

Time frame: September,1,2018-December 30, 2020

respiratory rate

Central Contacts

ling Liu, Phd

CONTACT

13851435472 liulingdoctor@126.com

haibo qiu, PhD

CONTACT

13951965301 haiboq@163.com

Data from ClinicalTrials.gov

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Secondary Outcomes

SBP

Recording SBP(systolic pressure, mmHg),which is always continuously monitored with invasive pressure monitor.

Time frame: September,1,2018-December 30, 2020

DBP

Recording DBP(Diastolic pressure, mmHg),which is always continuously monitored with invasive pressure monitor.

Time frame: September,1,2018-December 30, 2020

CVP

Recording CVP(central venous Pressure）,which is always discontinuously monitored with jugular pressure monitor mmHg).

Time frame: September,1,2018-December 30, 2020

vasopressor

Recording clinical vasopressor usage including Norepinephrine（ μg/Kg/min;）Epinephrine（μg/Kg/min） Dobutamine （ μg/Kg/min)

Time frame: September,1,2018-December 30, 2020