Effectiveness of Recruitment Maneuvers and Lung Protective Ventilation Strategy in ARDS

Asia University30 enrolled

Overview

The study was designed to comparison the effectiveness of recruitment maneuvers(RM) and lung protective ventilation strategy(LPVS) for patients with moderate to severe ARDS. ARDS patients were randomly divided into two groups, the experimental group (LPVS+RM group) and the control group (LPVS group). The method of RM refers to that under FiO2=100% oxygen concentration and fixed inspiratory pressure (15cmH2O), the PEEP starts from 10 cmH2O and increases at a pressure of 5 cmH2O every minute until the Peak inspiratory Pressure(PIP) reaches 55cmH2O, and the arterial blood oxygen is monitored at the same time. The pressure point when the partial pressure of arterial oxygen PaO2+PaCO2≧400mmHg is the best PEEP. The primary endpoint indicators were oxygenation index(OI) and lung ultrasound score(LUS) from day 1 to day 7. The secondary outcome indicators were the ventilator days, length of stay in the ICU (days), and ICU mortality.

ARDS patients were randomly divided into two groups, the experimental group (LPVS+RM group) and the control group (LPVS group). The method of RM refers to that under FiO2=100% oxygen concentration and fixed inspiratory pressure (15cmH2O), the PEEP starts from 10 cmH2O and increases at a pressure of 5 cmH2O every minute until the Peak inspiratory Pressure(PIP) reaches 55cmH2O, and the arterial blood oxygen is monitored at the same time. The pressure point when the partial pressure of arterial oxygen PaO2+PaCO2≧400mmHg is the best PEEP. The primary endpoint indicators were oxygenation index(OI) and lung ultrasound score(LUS) from day 1 to day 7. The secondary outcome indicators were the ventilator days, length of stay in the ICU (days), and ICU mortality.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

TRIPLE

Enrollment

Interventions

RMPROCEDURE

RM refers to that under FiO2=100% oxygen concentration and fixed inspiratory pressure (15cmH2O), the PEEP starts from 10 cmH2O and increases at a pressure of 5 cmH2O every minute until the Peak inspiratory Pressure(PIP) reaches 55cmH2O, and the level was fixed to 40 seconds in each increment. Then, the ventilator was transferred to PEEP-titration phase, the PEEP was adjusted to 25 cm H2O, and it was reduced by increments of 5 cm H2O each time. The each increment was fixed to 5 minutes till the end-maneuver PEEP.

LPVSPROCEDURE

LPVS was used by the pressure-controlled mode and the PEEP was titrated by the level of FiO2 to keep the saturation of oxygen (SaO2) more than 90%. The level of pressure control was adjusted to maintain low tidal volume (6-8 mL/kg predicted body weight \[PBW\]) strategy. The respiratory rate and tidal volume were setting to avoid unstable hemodynamic data and adjusted by blood gas data and lung mechanics.

Eligibility

Sex: ALLMin age: 20 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 20 to 70 years old. * Patients with hypoxemia receiving endotracheal mechanical ventilation therapy. * The ARDS diagnostic criteria of Berlin Definition, arterial oxygen tension \[PaO2\]/fractional inspired oxygen \[FiO2\] ratio (PaO2/FiO2) \<200 mm Hg, recent appearance of bilateral pulmonary infiltrates consistent with edema and no clinical evidence of left atrial hypertension. * Within 72 hours after ARDS diagnosis. Exclusion Criteria: * Pregnancy. * Participate in other interventional trials at the same time during the acceptance period. * Severe trauma combined with rib fracture or pneumothorax, subcutaneous emphysema, and mediastinal air accumulation within three months. * Severe chronic respiratory diseases that require long-term use of oxygen therapy or home mechanical ventilation. * Have a history of cachexia or terminal cancer. * Use immunosuppressants, chemotherapy or radiation therapy. * Contraindications for hypercapnia, such as patients with acute brain injury due to intracranial hypertension or craniotomy.

Outcomes

Primary Outcomes

Oxygenation index(OI)

Difference in OI between baseline and 72 hrs after enrollment 【The oxygenation index assesses the intensity of ventilatory support that is needed to maintain adequate oxygenation. The formula is: Oxygenation index = (FiO2 x PAW) / PaO2. The lower the OI(\<25) the better the outcome】

Time frame: Baseline - 72 hrs after enrollment

Lung ultrasound score(LUS)

Difference in LUS between baseline and 72 hrs after enrollment 【LUS is a score that measures lung aeration, score ranging from 0 to 36 points, the higher the score is mean the worse the ventilation of the lungs】

Time frame: Baseline - 72 hrs after enrollment

Secondary Outcomes

Ventilator days

Removal of endotracheal tube without ventilator support days

Time frame: Removal of endotracheal tube day - Insertion endotracheal tube day + 1 day

Length of stay in the ICU (days)

Total days of admission ICU

Time frame: Transfer out of ICU day - Admission to ICU day + 1 day

ICU mortality

In ICU death after admission to the ICU

Time frame: During ICU course