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The study was designed to understand the pathophysiology of gas exchange derangement in critically ill patients with COVID-19. Specifically we will evaluate the effect of 3 different levels of positive end-expiratory pressure (PEEP) and two different levels of inspiratory oxygen fraction (FiO2) on gas exchange by analyzing shunt and dead space. Furthermore, complete respiratory mechanics and distribution of ventilation and perfusion by electrical impedance tomography will be assessed at each level of PEEP.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Shunt-group | Experimental | Test of three different levels of positive end-expiratory pressure (PEEP) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PEEP trial - Electrical Impedance Tomography | Procedure | Three different levels of PEEP and two different levels of FiO2 will be tested without changing anything else in the baseline patient ventilation |
| Measure | Description | Time Frame |
|---|---|---|
| Shunt at three different levels of positive end expiratory pressure (PEEP) | Shunt measured by arterial and mixed venous blood samples at each level of PEEP | 30 minutes after change of positive end expiratory pressure (PEEP) level |
| Measure | Description | Time Frame |
|---|---|---|
| Dead space at three different levels of positive end expiratory pressure (PEEP) | Dead space measured by capnography at each level of PEEP | 30 minutes after change of positive end expiratory pressure (PEEP) level |
| Shunt and dead space at two different levels of inspiratory oxygen fraction for each level of positive end expiratory pressure (PEEP) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Giacomo Grasselli, Professor | Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ospedale Maggiore Policlinico | Milan | MI | 20122 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37926984 | Derived | Florio G, Zanella A, Slobod D, Guzzardella A, Protti I, Carlesso E, Canakoglu A, Fumagalli J, Scaravilli V, Colombo SM, Caccioppola A, Brioni M, Pesenti AM, Grasselli G. Impact of Positive End-Expiratory Pressure and FiO2 on Lung Mechanics and Intrapulmonary Shunt in Mechanically Ventilated Patients with ARDS Due to COVID-19 Pneumonia. J Intensive Care Med. 2024 May;39(5):420-428. doi: 10.1177/08850666231210485. Epub 2023 Nov 5. |
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| ID | Term |
|---|---|
| D012131 | Respiratory Insufficiency |
| ID | Term |
|---|---|
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
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Shunt measured by arterial and mixed venous blood samples and dead space measured by capnography at each level of PEEP |
| 30 minutes after change of positive end expiratory pressure (PEEP) level |
| Ventilation/perfusion at three different levels of positive end expiratory pressure (PEEP) assessed by electrical impedance tomography (EIT) | Ventilation/perfusion assessed by Electrical Impedance Tomography at each level of PEEP | 30 minutes after change of positive end expiratory pressure (PEEP) level |
| Respiratory mechanics at three different levels of positive end expiratory pressure (PEEP) | Respiratory mechanics (including esophageal pressure measurement) assessed at each level of PEEP by performing end-inspiratory and end-expiratory pauses | 30 minutes after change of positive end expiratory pressure (PEEP) level |