Effect of Electric Impedance Tomography-Guided PEEP Titration on the Ventilation-perfusion Mismatch in Moderate or Severe ARDS
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 69
- 试验地点
- 1
- 主要终点
- Difference in ventilation-perfusion mismatch between EIT-PEEP, low-PEEP, and high PEEP
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Intubated patients with moderate and severe ARDS (Berlin definition, PaO2/FiO2 ≤200 mmHg at PEEP 5 cmH2O)
- •undergoing deep sedation on controlled mechanical ventilation within72 hours after ARDS onset
排除标准
- •age <18 years old
- •patient undergoing legal protection
- •contra-indications to EIT (e. g. severe chest trauma or wounds)
- •pneumothorax
- •patient undergoing ECMO
结局指标
主要结局
Difference in ventilation-perfusion mismatch between EIT-PEEP, low-PEEP, and high PEEP
时间窗: 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.
次要结局
- recruitment-to-inflation (R/I) ratio(up to 24 hours)
- Difference in wasted perfusion measured with EIT between EIT-PEEP, low-PEEP, and high PEEP(up to 24 hours)
- ventilation distribution measured with EIT between EIT-PEEP, low-PEEP, and high PEEP(up to 24 hours)
- Correlations between ventilation-perfusion mismatch and overdistension and lung collapses(up to 24 hours)
- difference in center of ventilation (COV) between EIT-PEEP, low-PEEP, and high PEEP(up to 24 hours)
- Difference in dead space measured with EIT between EIT-PEEP, low-PEEP, and high PEEP(up to 24 hours)
- Difference in shunt measured with EIT between EIT-PEEP, low-PEEP, and high PEEP(up to 24 hours)
- Difference in wasted ventilation measured with EIT between EIT-PEEP, low-PEEP, and high PEEP(up to 24 hours)
- Correlation between V/Q mismatch markers and recruitability(up to 24 hours)
- perfusion distribution measured with EIT between EIT-PEEP, low-PEEP, and high PEEP(up to 24 hours)
- respiratory system mechanics(up to 24 hours)
- PaO2/FIO2(up to 24 hours)
研究者
Ling Liu
Director of Intensive Care Unit, Principal Investigator, Clinical Professor
Southeast University, China