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Expiratory or inspiratory transpulmonary pressures have been proposed to optimize ventilator settings in patients with ARDS. The aim of this study is to assess the feasibility and the physiological effects of a new method based on both expiratory and inspiratory transpulmonary pressures.
Expiratory or inspiratory transpulmonary pressures have been proposed to optimize ventilator settings in patients with ARDS. A positive expiratory transpulmonary pressure may be considered as a target to limt the risk of collapse in dependant lung regions. Some authors propose to titrate PEEP to target an inspiratory transpulmonary pressure of 20cmH20 to limit the risk of overdistension in non-dependant regions.The aim of this study is to assess the feasibility and the physiological effects of a new method based on both expiratory and inspiratory transpulmonary pressures.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Transpulmonary based ventilation strategy | Experimental | PEEP and tidal volume will be set to target expiratory and inspiratory transpulmonary pressures of 0 and 20 cmH2O, respectively. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PEEP and Tidal Volume Titration | Other | PEEP and Tidal Volume Titration According to Inspiratory and Expiratory Transpulmonary Pressures |
|
| Measure | Description | Time Frame |
|---|---|---|
| Ventilation strategy failure | Number of patients with failure criteria (barotrauma, hemodynamic failure, rescue therapy or acidemia) | 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Short term physiologicals effects on hemodynamics | Cardiac index assed by Echocardiography (L/min/m^2) | 45 minutes |
| All-cause mortality at day 28 | All-cause mortality |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Chu Angers | Angers | 49000 | France |
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feasibility, monocentric, prospective study
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| 28 days |
| Ventilator-free days at day 28 | Number of alive ventilator free days | 28 days |
| Short term physiologicals effects on respiratory mechanics | recruited lung volume (mL) | 45 minutes |
| Short term physiologicals effects on gas exchange | PaO2/FiO2 ratio (mmHg) | 45 minutes |
| Short term physiologicals effects on gas exchange | VD/VT | 45 minutes |
| Short term physiologicals effects on gas exchange | PaCO2 (mmHg) | 45 minutes |
| Short term physiologicals effects on respiratory mechanics | distribution of ventilation assed by electrical impedance tomography (COV, %) | 45 minutes |
| ID | Term |
|---|---|
| D012128 | Respiratory Distress Syndrome |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D012120 | Respiration Disorders |
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| ID | Term |
|---|---|
| D011175 | Positive-Pressure Respiration |
| ID | Term |
|---|---|
| D012121 | Respiration, Artificial |
| D058109 | Airway Management |
| D013812 | Therapeutics |
| D012138 | Respiratory Therapy |
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