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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Study group | Patients with moderate or severe ARDS treated with PP equipped with EIT will be included. Measurement of EIT data and ventilator spirometry in supine position and just after turning the patient in PP during a decremental PEEP-EIT titration, will be done, and blood gases and finally haemodynamic data |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 48 hours after inclusion day |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 48 hours after inclusion day |
| Repartition of regional ventilation in each part of the lungs. |
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Inclusion Criteria:
Exclusion Criteria:
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Patients hospitalised in the thoracic intensive care unit, with moderate or severe ARDS according to the Berlin criteria, requiring a prone position, treated with PP equipped with EIT, will be included.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Benjamin REPUSSEAU, Dr | Contact | 05 57 65 68 66 | +33 | benjamin.repusseau@chu-bordeaux.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CH Cote Basque | Recruiting | Bayonne | 64000 | France |
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| ID | Term |
|---|---|
| D012128 | Respiratory Distress Syndrome |
| D001261 | Pulmonary Atelectasis |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D012120 | Respiration Disorders |
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| ID | Term |
|---|---|
| D013812 | Therapeutics |
| D016684 | Prone Position |
| ID | Term |
|---|---|
| D011187 | Posture |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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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). |
| 48 hours after inclusion day |
| Hopital Haut-Lévêque | Recruiting | Pessac | 33604 | France |
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