Effect of PEEP and Trendelenburg on Ultrasound Size of Internal Jugular and Subclavian Veins
- Conditions
- Ventilated Patient in Intensive CareManagement of the Expiratory End-expiratory Pressure (PEEP) and Body Position
- Interventions
- Behavioral: Patient's position
- Registration Number
- NCT02569424
- Lead Sponsor
- University Hospital, Clermont-Ferrand
- Brief Summary
There is no recommendation for the management of the positive end-expiratory pressure (PEEP) during setting of a central venous catheter (CVC) in a ventilated patient. Several non-randomized studies have investigated the cross-sectional area (AST) ultrasound minor axis for different pressure levels by evaluating a single vessel every time or by not displaying the right or left side in the evaluation. Another study showed that there could be unpredictable size differences between the 2 subclavian veins.
In ventilated patient, the PEEP, which is intrathoracic, will result in a decrease of venous return and thus possibly a superior vena cava dilation, located outside the pleura, depending on their capacitance. Different pressure levels showed an increase of AST with the increase of intra-thoracic pressure on certain veins, in a heterogeneous and not randomized manner.
The primary purpose of the study is to measure the effect of PEEP (0, 5, 10 or 15 cm H2O) and the patient's position (supine or Trendelenburg strict -15-20 °) on the cross-sectional area of the jugular and subclavian veins.
- Detailed Description
There is no recommendation for the management of the positive end-expiratory pressure (PEEP) during setting of a central venous catheter (CVC) in a ventilated patient. Several non-randomized studies have investigated the cross-sectional area (AST) ultrasound minor axis for different pressure levels by evaluating a single vessel every time or by not displaying the right or left side in the evaluation. Another study showed that there could be unpredictable size differences between the 2 subclavian veins.
In ventilated patient, the PEEP, which is intrathoracic, will result in a decrease of venous return and thus possibly a superior vena cava dilation, located outside the pleura, depending on their capacitance. Different pressure levels showed an increase of AST with the increase of intra-thoracic pressure on certain veins, in a heterogeneous and not randomized manner.
The primary purpose of the study is to measure the effect of PEEP (0, 5, 10 or 15 cm H2O) and the patient's position (supine or Trendelenburg strict -15-20 °) on the cross-sectional area of the jugular and subclavian veins.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 42
- Any patient ventilated in intensive care is eligible.
- Age ≥ 18 years
- Patient with stable hemodynamic status and Mean Blood Pressure (< 65 mmHg)
- Patient with registered social security number
- clinical sign for a central venous thrombosis (unilateral edema ...).during echography screening before inclusion
- presence of a central line for more than 48 hours.
- Anechoic patient (checked during echography screening)
- History of cervical spine surgery.
- IntraCranial HyperTension
- patient in shock with hemodynamic instability and not stabilized
- patient treated by noradrenaline > 1 µg/kg/min
- patient or relative's refusal
- protected patients ≥ 18 years, minors, pregnant women
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description ventilated patients Patient's position Patient's position (Supine or Trendelenburg strict -20°)
- Primary Outcome Measures
Name Time Method The cross-sectional area of the jugular veins ( in cm2) at baseline The cross-sectional area of the jugular veins ( in cm2) at the end of the intervention
- Secondary Outcome Measures
Name Time Method The cross-sectional area of the subclavian veins ( in cm2) at baseline The cross-sectional area of the subclavian veins ( in cm2) at the end of the intervention
The antero-posterior diameter of the jugular veins (in mm) at baseline The antero-posterior diameter of the jugular veins (in mm) at the end of the intervention
The antero-posterior diameter of the subclavian veins (in mm) at baseline The antero-posterior diameter of the subclavian veins (in mm) at the end of the intervention
The distance between posterior and pleural lining of the jugular veins (in mm) at baseline The distance between posterior and pleural lining of the jugular veins (in mm) at the end of the intervention
The distance between posterior and pleural lining of the subclavian veins (in mm) at baseline The distance between posterior and pleural lining of the subclavian veins (in mm) at the end of the intervention
Trial Locations
- Locations (1)
CHU Clermont-Ferrand
🇫🇷Clermont-Ferrand, France