Titration of Positive End-expiratory Pressure: Comparison Between Manual Thoracic or Abdominal Compression and Electrical Impedance Tomography
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: PEEP titrations.
- Who it may be relevant to
- Registry conditions: ARDS (Acute Respiratory Distress Syndrome). Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- France
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
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
Detailed description
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.
Interventions
- Other PEEP titrations
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.
Primary outcome measures
- PEPCTAC [Time frame: Day 0]
- PEPCAC [Time frame: Day 0]
- PEPEIT [Time frame: Day 0]
Secondary outcome measures (12)
- Percentage of collapse at PEPCTAC [Time frame: Day 0]
- Percentage of collapse at PEPCAC [Time frame: Day 0]
- Percentage of collapse at PEPEIT [Time frame: Day 0]
- Compare respiratory mechanics for PEPCTAC and PEPCAC and PEPEIT [Time frame: Day 0]
- Compare PEPCTAC and other PEEP adjustment methods reported in the literature [Time frame: Day 0]
- Evaluate the effect of CTAC on plateau pressure based on levels of distension and collapse resulting from PEEP [Time frame: Day 0]
- Evaluate the effect of CTAC on plateau pressure based on levels of collapse resulting from 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 [Time frame: Day 0]
- Evaluate the effects of CTAC on regional compliance according to the level of PEP [Time frame: Day 0]
- Evaluate the effect of recruitability potential on the level of PEPCTAC and PEPEIT [Time frame: Day 0]
- Evaluate the effect of airway opening pressure on the level of PEPCTAC and PEPEIT [Time frame: Day 0]
- Evaluate the effects of PEEP on right ventricular function [Time frame: Day 0]
Eligibility criteria
Inclusion criteria
- Age ≥ 18 years
- Moderate to severe ARDS according to the Berlin criteria
- Patient receiving sedation and continuous curarization
- Free and informed consent from the patient or their loved one
Exclusion criteria
- ECMO
- Pneumothorax
- Chest trauma in the last 3 months
- Uncontrolled shock (noradrenaline > 5 mg/h)
- Pregnant or breastfeeding woman
- Protected adult within the meaning of the law
- Lack of social security
- Patient under AME
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- N/A
- Model
- Single group
- Masking
- Open label
- Primary purpose
- Other
Study locations
France · 2 centers
- GHU Henri Mondor — Créteil
- Hôpital Saint Joseph Saint Luc — Lyon
Identifiers
NCT: NCT07623590 · TICTAC