Patients with acute respiratory distress syndrome are placed on mechanical ventilation, and the adjustment of ventilator parameters is an important step in their care, in particular positive expiratory pressure, applied at the end of breathing. The goal of this study is to learn if continuous anterior chest compression works as well as electrical impedance tomography for positive expiratory pressure titration. Researchers will compare the two methods for each patient, in a randomly determined order : continuous anterior chest compression and electrical impedance tomography. Participants will : * have a pep titration with both techniques * be included in the study for 28 days
Personalizing the PEEP level is an important step in ventilator adjustment in ARDS patients. The investigators have developed a simple, low-cost method to detect overdistension of the lung, consisting of applying manual compression to the anterior aspect of the patient's thorax, and observing whether the ventilator pressure increases or decreases. The investigators hypothesize that with this simple method it is possible to determine the PEEP level which corresponds to that determined with EIT.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
30
Assessment of ideal PEEP using electrical impedance tomography will be performed. The evaluation of PEEP using the thorax compression maneuver method will be carried out. A blood sample (the "blood gases") will be taken at the ideal PEEP determined by electrical impedance tomography and at the ideal PEEP determined by the manual chest compression maneuver.
GHU Henri Mondor
Créteil, France
RECRUITINGHôpital Saint Joseph Saint Luc
Lyon, France
RECRUITINGPEPCTAC
PEPCTAC (unit : cmH2O)
Time frame: Day 0
PEPCAC
PEPCAC (unit : cmH2O)
Time frame: Day 0
PEPEIT
PEPEIT (unit : cmH2O)
Time frame: Day 0
Percentage of collapse at PEPCTAC
Percentage of collapse at PEPCTAC
Time frame: Day 0
Percentage of collapse at PEPCAC
Percentage of collapse PEPCAC
Time frame: Day 0
Percentage of collapse at PEPEIT
Percentage of collapse at PEPEIT
Time frame: Day 0
Compare respiratory mechanics for PEPCTAC and PEPCAC and PEPEIT
Respiratory mechanics at PEPCTAC and PEPCAC ans PEPEIT : peak and plateau pressure, driving pressure, respiratory system compliance, pulmonary and parietal compliance, respiratory system resistance, end-expiratory transpulmonary pressure, stress index at each PEEP level
Time frame: Day 0
Compare PEPCTAC and other PEEP adjustment methods reported in the literature
Comparison of the PEPCTAC level to the PEP level according to the maximum recruitment arm of the Express study (PEP level which is accompanied by a Pplat between 28 and 30 cm H2O), Comparison of the PEPCTAC level to the PEP level according to the PEP/FiO2 scales, Comparison of the PEPCTAC level to the minimum PEEP level to obtain a positive end-expiratory transpulmonary pressure
Time frame: Day 0
Evaluate the effect of CTAC on plateau pressure based on levels of distension and collapse resulting from PEEP
• Correlation between variation of plateau pressure with CTAC and percentage of distension linked to PEEP
Time frame: Day 0
Evaluate the effect of CTAC on plateau pressure based on levels of collapse resulting from PEEP
• Correlation between variation of plateau pressure with CTAC and percentage of collapsus linked to PEEP
Time frame: Day 0
Evaluate the effect of CTAC on plateau pressure based on the distribution of ventilation between dependent and non-dependent zones resulting from PEEP
Correlation between variation of plateau pressure with CTAC and percentage of anterior ventilation
Time frame: Day 0
Evaluate the effects of CTAC on regional compliance according to the level of PEP
Regional compliances (four areas of interest with antero-posterior distribution) of the respiratory and pulmonary system estimated using EIT, airway pressure and esophageal pressure
Time frame: Day 0
Evaluate the effect of recruitability potential on the level of PEPCTAC and PEPEIT
R/I ratio
Time frame: Day 0
Evaluate the effect of airway opening pressure on the level of PEPCTAC and PEPEIT
Evaluation of the airway opening pressure by performing a slow flow pressure-volume curve (quasi-static condition) from a PEEP set at zero cm H2O
Time frame: Day 0
Evaluate the effects of PEEP on right ventricular function
Right ventricular function assessed by echocardiography: mitral inflow, subaortic VTI, subpulmonary VTI, continuous-wave pulmonary Doppler and assessment of pulmonary regurgitation, continuous Doppler, TAPSE (tricuspid annular plane systolic excursion), tricuspid annular S-wave. Presence of acute cor pulmonale defined by an RV/LV ratio \> 0.6 associated with paradoxical septal motion, PAPi (pulmonary artery pulsatility index). Septal and free-wall right ventricular strains.
Time frame: Day 0
Evaluate the effect of PEEP on venous congestion
Venous congestion assessed by ultrasound (VExUS score)
Time frame: Day 0
Compare the percentages of distension between PEPCTAC and PEPCAC and PEPEIT
Percentages of distension between PEPCTAC and PEPCAC and PEPEIT
Time frame: Day 0
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