EIT Assessment of Overdistension in ARDS Patients in Prone Position

University Hospital, Bordeaux20 enrolled

Overview

Mechanical ventilation in ARDS requires protective ventilation with low VT and PEEP. PEEP titration can improve lung recruitment in the dependent lung but with a risk of overdistension in the non-dependant lung. EIT can measure the distribution of tidal ventilation and assess overdistension and collapse during a PEEP titration in any position (prone or not). This study aims to measure the best PEEP as a compromise between recruitment and overdistension during a PEEP trial with EIT before and just after PP.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Acute Respiratory Distress Syndrome

Interventions

Acute Respiratory Distress Syndrom (ARDS) treated with Prone Position (PP) equipped with Electrical Impedance Tomography (EIT)OTHER

Positive End-Expiratory Pressure (PEEP) will be titrated with PEEP-EIT method as it is already done in usual care. A classical low flow Pression Volume (PV) curve will be done in order to detect airway closure and measure compliance, the acquisition of EIT data during PV curve will be analysed secondary with a dedicated software. Reconstruction of EIT derived PV curve will determine the regional airway opening pressures and compliances of the 2 lungs. Two decremental PEEP-EIT titrations will be compared, one in supine and the other just after turning in prone.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients hospitalized in the ICU and who suffered moderate or severe ARDS (Berlin criteria, PaO2/FiO2\<150), intubated sedated, under myorelaxant and equipped with EIT * Over the age of 18. Exclusion Criteria: * Broncho-pleural leaks * Pregnant or breastfeeding woman. * Guardianship or curatorship * Deprived of liberty * No health insurance * Impossibility to correctly position the EIT belt (e.g., dressings, chest drainage, etc.) * Contra indications to EIT (e.g., implantable cardiac defibrillator, pacemaker, instable spinal lesions)

Locations (2)

CH Cote Basque

Bayonne, France

RECRUITING

Hopital Haut-Lévêque

Pessac, France

RECRUITING

Outcomes

Primary Outcomes

Level of distension

Assessing the level of distension when titrating the optimal PEEP in the supine position (SP) and in the PP position the first and second day of ARDS in PP. The measure will be obtained thanks to the crossing in EIT of the overdistension curve and the collapse curve when the PEEP is reduced from 20 to 5 cmH2O.

Time frame: 48 hours after inclusion day

Secondary Outcomes

Comparison of the percent of overdistension and collapse during the EIT-PEEP titration

Thanks to PEEP-EIT titration in PP and SP the percent of collapse and global over-distension in EIT will be evaluate.

Time frame: 48 hours after inclusion day

Repartition of regional ventilation in each part of the lungs.

Thanks to PV-EIT curve, the measurement of regional Airway Opening Pressure (anterior vs posterior) will be evaluate (lower inflection point of the PV-EIT curve).

Time frame: 48 hours after inclusion day

Central Contacts

Benjamin REPUSSEAU, Dr

CONTACT

05 57 65 68 66 benjamin.repusseau@chu-bordeaux.fr

Data from ClinicalTrials.gov

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