Effects of Continuous Anterior Chest Compression

Assistance Publique - Hôpitaux de Paris20 enrolled

Overview

The aim is to test the physiological effects of continuous anterior chest compression in patients with severe to moderate ARDS.

Acute respiratory distress syndrome (ARDS) is usually characterized by inhomogeneous lesions, leading to an inhomogeneous distribution of the mechanical ventilation with the following several deleterious effects: atelectrauma of dependent posterior areas and overdistension in the anterior ones. Therefore, the gold standard treatment is to prevent VILI with lung protective ventilation : low tidal volume, high positive end expiratory pressure and prone positioning which is a technique that reduces mortality. Prone positioning has several beneficial effects : it relieves cardiac compression of the supporting lung, it stiffens the anterior chest wall thus limiting the risk of overdistension of anterior areas and promotes recruitment of non-dependent posterior pulmonary units. The overall effect is a more uniform distribution of transpulmonary pressures and improved ventilation to perfusion ratios. Similar to prone positioning, continuous anterior chest wall compression stiffens the anterior chest wall. The investigators hypothesize that such reduction in anterior chest wall compliance may protect against overdistension and promote the redistribution of the ventilation in posterior areas.

Study Type

INTERVENTIONAL

Allocation

Purpose

BASIC_SCIENCE

Masking

NONE

Enrollment

Conditions

Evaluable

Interventions

Continuous anterior chest compressionDEVICE

Patients with severe to moderate ARDS who were placed in prone position by the attending physician : * First CACC : the applied pressure is equal to the one observed in the prone position * Second CACC : The applied pressure is set at 60 - 80 cmH20

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥ 18 ans * Intubated moderate and severe ARDS according to the Berlin definition (PaO2/FiO2 ratio \<= 200 mmHg) * The patent must be sedated and paralyzed * Informed consent from patient or family members Exclusion Criteria: * Extracorporeal membrane oxygenation (ECMO) * Pneumothorax * Thoracic trauma during the last 3 months * Refractory shock * Contraindication to EIT monitoring (e.g. burns, pacemaker, thoracic wounds limiting electrode belt placement) * Pregnancy * Any contra-indication to esophageal manometry (less than one month esophagus surgery, bronchopleural or esotracheal fistula, latex allergy) * No social care * Adults under Guardianship, curatorship or protection of the court

Locations (1)

Assistance Publique Hôpitaux de Paris - CHU HENRI MONDOR

Créteil, France

Outcomes

Primary Outcomes

The end inspiratory transpulmonary pressure (PL-insp) in centimetre of water

The transpulmonary pressure will be measured by using an esophageal catheter connected to a differential pressure transducer. The PL-insp will be calculated using the ratio between the elastance of the lung (El) and of the respiratory system (Ers) expressed in centimetre of water thanks to this formula PL-insp = Plateau pressure x (El/Ers). The PL-insp between the different protocol conditions will be compared (After 16 hours of prone position, in supine position, 15mn after CACC with a pressure equal to the one observed in the prone position, 15mn after CACC with a pressure set at 60 - 80 cmH20, 15mn after taking off the CACC in supine position ). CACC will be considered protective if there is a decrease in Pl-insp.

Time frame: Through study completion (up to 6 hours)

Secondary Outcomes

Regional pulmonary compliances in centimetre of water

Evaluation and comparison of pulmonary compliances in the different regions of interest (ROI) measured by Electrical Impedance Tomography (EIT) in the different protocol conditions.

Time frame: Through study completion (up to 6 hours)

Lung mechanics : Airways pressure, Flow curves and Esophageal pressure

Airways pressure (Paw) will be measured in cmH2O and recorded by the mean of a differential pressure transducer. Flow curves will be measured in L/mn and recorded by the mean of a pneumotachograph connected to the ventilator circuit. Esophageal pressure (Pes) will be measured in cmH2O and recorded thanks to an esophageal balloon catheter introduced in the mid-esophagus of the patient and connected to differential pressure transducer. Evaluation and comparison of respiratory mechanics in the different protocol conditions.

Time frame: Through study completion (up to 6 hours)

Pulmonary ventilation distribution in percentage

Evaluation and comparison of the distribution of ventilation in the different regions of interest (ROI) measured by Electrical Impedance Tomography (EIT) in the different protocol conditions

Data from ClinicalTrials.gov

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