Assessing Optimal Positive End-expiratory Pressure (PEEP) Using Electrical Impedance Tomography (EIT) During a PEEP Titration Protocol in Mechanically Ventilated Children with Pediatric Acute Respiratory Distress Syndrome (PARDS)
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Pediatric Acute Respiratory Distress Syndrome
- Sponsor
- Children's Hospital Los Angeles
- Enrollment
- 60
- Locations
- 1
- Primary Endpoint
- The absolute difference between the electrical impedence tomography (EIT) recommended PEEP and the PEEP recommended by the PEEP/fraction of inspired oxygen (FiO2) grid.
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
The goal of this clinical trial is to perform a PEEP titration protocol and use EIT to identify the optimal PEEP at which lung overdistention and collapse are most effectively balanced. The primary and secondary aims of the study are as follows:
Identify the difference between the optimal PEEP recommended by EIT metrics and the current guideline recommended approach to identifying optimal PEEP in PARDS. There will be a statistically significant difference in the recommended optimal PEEP identified using the EIT PEEP titration tool and that of the PEEP/FiO2 grid recommendations.
Determine the difference in physiologic metrics between EIT optimal PEEP and the PEEP/FiO2 recommended PEEP.
Participants will undergoing EIT monitoring while being subjected to PEEP titration protocol.
Investigators
Anoopindar Bhalla
Medical Staff/USC Faculty
Children's Hospital Los Angeles
Eligibility Criteria
Inclusion Criteria
- •Any person who is less than 18 years of age
- •is on invasive mechanical ventilation
- •is not spontaneously breathing
- •meets PARDS criteria
Exclusion Criteria
- •Contraindication to the use of EIT
- •Hemodynamic instability
- •Contraindications to hypercapnia
- •patients with uncuffed endotracheal or tracheostomy tubes
- •diagnosis of pneumothorax or bronchopleural fistula
- •non-conventional ventilation
- •any patient on extra-corporeal membrane oxygenation (ECMO) support
- •less than 1 week post-operatively from cardiac surgery
- •the following cardiac diagnoses: Glenn or Fontan physiology, significant right to left shunt
- •Corrected Gestational Age \< 37 weeks
Outcomes
Primary Outcomes
The absolute difference between the electrical impedence tomography (EIT) recommended PEEP and the PEEP recommended by the PEEP/fraction of inspired oxygen (FiO2) grid.
Time Frame: Day 1
Collected using electrical impedence tomography (EIT). The EIT device provides the percentages of alveolar overdistention and collapse at each PEEP level. The best PEEP by EIT is defined as the PEEP level above the intersection of curves representing relative alveolar overdistention and collapse.
Secondary Outcomes
- Lung recruitability, as measured by electrical impedence tomography, and its association with difference in optimal PEEP recommended by electrical impedence tomography versus the PEEP/FiO2 grid(Day 1)
- Difference in systolic impendence, as a surrogate for cardiac output, using electrical impedence tomography at various PEEP levels(Day 1)
- Change in static compliance across different PEEP levels during a PEEP titration(Day 1)
- Change in driving pressure across different PEEP levels during a PEEP titration(Day 1)
- Change in plateau pressure across different PEEP levels during a PEEP titration(Day 1)
- Change in dead space, as measured by volumetric capnography, across different PEEP levels during a PEEP titration(Day 1)
- Change in transplural pressure, as measured by esophageal manometry, across different PEEP levels during a PEEP titration(Day 1)