Effect of Electric Impedance Tomography-Guided PEEP Titration

Not Applicable

Completed

• Conditions: ARDS, Human
• Interventions: Device: PEEP selection

• Registration Number: NCT05736185
• Lead Sponsor: Southeast University, China

Brief Summary

Acute respiratory syndrome distress (ARDS) is a clinical common syndrome with high mortality. Mechanical ventilation (MV) is the cornerstone of management of ARDS but can lead to ventilator-induced lung injury. Positive end-expiratory pressure (PEEP), as one of main component of MV, has been widely used in the clinical practice. However, how to best set PEEP is still a difficult problem for moderate to severe ARDS patients. EIT, an imaging tool evaluating the regional ventilation distribution at the bedside, can achieve the individual PEEP selection for all mechanically ventilated patients. This article compared the effect of PEEP titrated guided by EIT with fraction of inspired oxygen (FiO2)-PEEP table on the ventilation-perfusion mismatch.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2023-02-09
• Study First Submitted QC: 2023-02-09
• Study First Posted: 2023-02-21
• Study Start: 2023-02-25
• Primary Completion: 2024-05-30
• Study Completion: 2024-05-30
• Status Verified: 2024-06
• Last Update Submitted: 2024-06-01
• Last Update Posted: 2024-06-04

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 69

Inclusion Criteria

1. Intubated patients with moderate and severe ARDS (Berlin definition, PaO2/FiO2 ≤200 mmHg at PEEP 5 cmH2O)
2. undergoing deep sedation on controlled mechanical ventilation within72 hours after ARDS onset

Exclusion Criteria

1. age <18 years old
2. patient undergoing legal protection
3. contra-indications to EIT (e. g. severe chest trauma or wounds)
4. pneumothorax
5. patient undergoing ECMO
6. pregnancy

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
High FiO2-PEEP strategy	PEEP selection	PEEP selected by high FiO2-PEEP table which remained at 15 min
Low FiO2-PEEP strategy	PEEP selection	PEEP selected by low FiO2-PEEP table which remained at 15 min
EIT-PEEP strategy	PEEP selection	PEEP selected by EIT which remained at 15 min

Primary Outcome Measures

Name	Time	Method
Difference in ventilation-perfusion mismatch between EIT-PEEP, low-PEEP, and high PEEP	up to 24 hours	EIT-PEEP was obtained by EIT, low-PEEP was obtained by low FIO2-PEEP table, and high-PEEP was obtained by high FIO2-PEEP table.

Secondary Outcome Measures

Name	Time	Method
difference in center of ventilation (COV) between EIT-PEEP, low-PEEP, and high PEEP	up to 24 hours	COV was obtained by EIT monitoring
Difference in dead space measured with EIT between EIT-PEEP, low-PEEP, and high PEEP	up to 24 hours	dead space was obtained by EIT monitoring
Difference in shunt measured with EIT between EIT-PEEP, low-PEEP, and high PEEP	up to 24 hours	shunt was obtained by EIT monitoring
Difference in wasted ventilation measured with EIT between EIT-PEEP, low-PEEP, and high PEEP	up to 24 hours	wasted ventilation was obtained by EIT monitoring
recruitment-to-inflation (R/I) ratio	up to 24 hours	recruitment-to-inflation (R/I) ratio was computed between the two PEEP levels
Difference in wasted perfusion measured with EIT between EIT-PEEP, low-PEEP, and high PEEP	up to 24 hours	wasted perfusion was obtained by EIT monitoring
ventilation distribution measured with EIT between EIT-PEEP, low-PEEP, and high PEEP	up to 24 hours	ventilation distribution was obtained by EIT in difference regions
Correlations between ventilation-perfusion mismatch and overdistension and lung collapses	up to 24 hours	Overdistension (%) and lung collapses (%) will be assessed by EIT. These two values cannot be measured separately. V/Q mismatch will be computed by EIT, and expressed in %. Correlation will be performed by linear regression.
Correlation between V/Q mismatch markers and recruitability	up to 24 hours	Recruitability will be assessed between 15 and 5 cmH2O by respiratory mechanics, as the recruited volumes value (in mL). R/I ratio will be derived from these data (no unit). V/Q mismatch will be computed by EIT, and expressed in %. Correlation will be performed by linear regression.
perfusion distribution measured with EIT between EIT-PEEP, low-PEEP, and high PEEP	up to 24 hours	perfusion distribution was obtained by EIT in difference regions
respiratory system mechanics	up to 24 hours	respiratory system compliance included lung compliance, chest wall compliance, and respiratory system compliance. respiratory system resistance will be computed as the inverse of compliance.
PaO2/FIO2	up to 24 hours	PaO2/FIO2 was obtained by gas analysis

Trial Locations

Locations (1)

Zhongda Hospital, School of Medicine, Southeast University; 🇨🇳 Nanjing, Jiangsu, China