The aim of this observationnal study is to describe respiratory mechanics and lung recruitement in patients with SARS-CoV-2 Associated Acute Respiratory Distress Syndrome who underwent invasive ventilation on endotracheal tube, admitted to the medical ICU of Angers university hospital . Statics measurements of respiratory system compliance were performed at 2 differents levels of PEEP (15 cmH2O and 5 cmH2O). The recruited volume is computed as the difference between the volume expired from PEEP 15 to 5 cmH2O and the volume predicted by compliance at PEEP 5 cmH2O . The recruitment-to-Inflation (R/I) ratio (i.e. the ratio between the recruited lung compliance and CRS at PEEP 5 cmH2O) is used to assess lung recruitability. A R/I ratio value higher than or equal to 0.5 was used to define highly recruiter patients.
The investigators perform an observational prospective study in patients admitted to medical ICU in Angers University hospital with a confirmed COVID 19 pneumonia and who require invasive ventilation on endotracheal tube. Participants receive initially deep sedation and neuromuscular blockers for 24 hours and are ventilated in volume-controlled mode with a tidal volume of 6 mL/kg of predicted body weight, a constant inspiratory flow of 60 L/minute and a respiratory rate adjusted to maintain pH above 7.35 when possible. A PEEP decremental trial from 15 to 5 cmH2O was performed (15 minutes by step). Esophageal pressure monitoring and electrical impedance tomography (EIT) are collected if available. Arterial blood gases and respiratory mechanics are measured at the end of each step. The recruitment-to-Inflation (R/I) ratio (i.e. the ratio between the recruited lung compliance and CRS at PEEP 5 cmH2O) is used to assess lung recruitability. A R/I ratio value higher than or equal to 0.5 is used to define highly recruiter patients. By the end of the recording time, a low-flow (5 L/min) inflation from PEEP 5 cmH2O (tidal volume = 6ml/kg PBW) is then performed after a prolonged expiration to identify a potential airway closure and the corresponding airway opening pressure (AOP). Investigators perform these measurements at day 1, day 5 and day 10 from ICU admission if participants still require controlled ventilation. The investigators also collect clinical data about each participant (past medical history, ICU discharge, hospital discharge, date of death, ventilator acquired pneumonia, thromboembolic event, use of NO, use of ECMO or renal replacement therapy).
Study Type
OBSERVATIONAL
Enrollment
50
Measurement of Recruitment-to-Inflation Ratio
CHU
Angers, France
RECRUITINGRecruitment-to Inflation ratio (R/I ratio)
no unit
Time frame: Day 1
Recruitment-to Inflation ratio (R/I ratio)
no unit
Time frame: Day 5
Recruitment-to Inflation ratio (R/I ratio)
no unit
Time frame: Day 10
PaO2/FiO2 (mmHg)
Arterial blood gases
Time frame: Day 1
PaO2/FiO2 (mmHg)
Arterial blood gases
Time frame: Day 5
PaO2/FiO2 (mmHg)
Arterial blood gases
Time frame: Day 10
Lung volume recruited (VRec)
mL
Time frame: Day 1
Lung volume recruited (VRec)
mL
Time frame: Day 5
Lung volume recruited (VRec)
mL
Time frame: Day 10
Plateau pressure (cm H2O)
Obtained by inspiratory pause of 5 seconds
Time frame: Day 1
Plateau pressure (cm H2O)
Obtained by inspiratory pause of 5 seconds
Time frame: Day 5
Plateau pressure (cm H2O)
Obtained by inspiratory pause of 5 seconds
Time frame: Day 10
Oesophagal pressure (cm H2O)
Time frame: Day 1
Oesophagal pressure (cm H2O)
Time frame: Day 5
Oesophagal pressure (cm H2O)
Time frame: Day 10
weight (Kg)
Time frame: Day 1
weight (Kg)
Time frame: Day 5
weight (Kg)
Time frame: Day 10
urine output (mL)
Time frame: day 1
urine output (mL)
Time frame: day 5
urine output (mL)
Time frame: day 10
serum creatinine (Umo/L)
Time frame: day 1
serum creatinine (Umo/L)
Time frame: day 5
serum creatinine (Umo/L)
Time frame: day 10
Mean arterial pressure (mmHg)
Time frame: day 1
Mean arterial pressure (mmHg)
Time frame: day 5
Mean arterial pressure (mmHg)
Time frame: day 10
Peak Pressure (cm H2O)
Time frame: Day 1
Peak Pressure (cm H2O)
Time frame: Day 5
Peak Pressure (cm H2O)
Time frame: Day 10
PEEP total (cm H2O)
Obtained by expiratory pause of 5 seconds
Time frame: Day 1
PEEP total (cm H2O)
Obtained by expiratory pause of 5 seconds
Time frame: Day 5
PEEP total (cm H2O)
Obtained by expiratory pause of 5 seconds
Time frame: Day 10
PEP Set (cm H2O)
Time frame: Day 1
PEP Set (cm H2O)
Time frame: Day 5
PEP Set (cm H2O)
Time frame: Day 10
Height (cm)
Time frame: Day 1
Airway pening pressure (cm H2O)
Time frame: day 1
Airway pening pressure (cm H2O)
Time frame: day 5
Airway pening pressure (cm H2O)
Time frame: day 10
Expired volume in PEEP setted at 15 cmH2O (mL)
respiratory rate decreased to 10 /min, expired tidal volume displayed by the ventilator is noted
Time frame: Day 1
Expired volume in PEEP setted at 15 cmH2O (mL)
respiratory rate decreased to 10 /min, expired tidal volume displayed by the ventilator is noted
Time frame: Day 5
Expired volume in PEEP setted at 15 cmH2O (mL)
respiratory rate decreased to 10 /min, expired tidal volume displayed by the ventilator is noted
Time frame: Day 10
Expired volume in PEEP setted at 5 cmH2O (mL)
respiratory rate decreased to 10 /min, expired tidal volume displayed by the ventilator is noted
Time frame: Day 1
Expired volume in PEEP setted at 5 cmH2O (mL)
respiratory rate decreased to 10 /min, expired tidal volume displayed by the ventilator is noted
Time frame: Day 5
Expired volume in PEEP setted at 5 cmH2O (mL)
respiratory rate decreased to 10 /min, expired tidal volume displayed by the ventilator is noted
Time frame: Day 10
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