Prone Position and Renal Resistive Index
- Conditions
- Acute Kidney InjuryAcute Respiratory Distress SyndromeProne PositionIntra-Abdominal Hypertension
- Interventions
- Other: Prone position
- Registration Number
- NCT04286490
- Lead Sponsor
- University Hospital, Grenoble
- Brief Summary
Patients suffering from Acute Respiratory Distress Syndrome (ARDS) with a prone position (PP) indication will benefit from measurements of renal resistive index, intra-abdominal pressure (IAP), urinary oxygen tension (uPO2) and ventilatory mechanics in supine position (baseline IAP), after 2 hours in PP at the current IAP value, thirty minutes after patients' abdomen suspension in order to resume baseline IAP and after patients' are turned back to supine position.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 20
- ARDS patients according to Berlin criteria, intubated, mechanically ventilated
- with PaO₂/FiO₂ < 150 mmHg,
- neuromuscular blockade
- with an indication of PP done by the physician in charge
- possibility to differ PP for one hour
- patients should be hemodynamically stable since at least 4 hours
- Pregnant or breast-feeding women
- legal protection, no social security affiliation
- PP contra-indication
- nasogastric tube contra-indication
- extra corporeal membrane oxygenation
- acute kidney injury at inclusion according to K-DIO criteria, chronic kidney disease defined as an estimated glomerualr filtration rate less than 30 ml/min/1.73m², kidney transplantation, renal artery stenosis, solitary kidney, albuminuria > 1.25 mg/ml
- cardiac arrhythmia
- obesity
- advanced cirrhosis
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Prone position Prone position -
- Primary Outcome Measures
Name Time Method change in renal resistive index (RRI) At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver RRI measurement will be performed on a right kidney arcuate/interlobar artery, with a high frequency Doppler probe. Three to five consecutive measures will be obtained then RRI computed according to the formula: (peak systolic velocity - end diastolic velocity)/peak systolic velocity).
- Secondary Outcome Measures
Name Time Method change in renal medullary oxygen tension At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver urinary oxygen tension (uPO₂) will be measured via a fiber-optic luminescence optode inserted through the bladder catheter lumen
Persisting effect of IAP increase in prone position when patients are back in supine position on urinary PO2 Two hours after patients are back in supine position urinary oxygen tension (uPO₂) will be measured via a fiber-optic luminescence optode inserted through the bladder catheter lumen
ventilatory mechanics: transpulmonary pressure At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver transpulmonary pressure will be measured at the end of inspiration and expiration and continuously recorded on a datalogger
ventilatory mechanics: driving pressure At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver driving pressure will be measured at the end of inspiration and expiration and continuously recorded on a datalogger
ventilatory mechanics: elastance At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver elastance will be measured at the end of inspiration and expiration and continuously recorded on a datalogger
haematosis At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver arterial oxygen tension (PaO2) and arterial dioxide carbon tension (PaC02)
Intra abdominal pressure At inclusion (in supine position), two hours after prone positioning, 30-minutes after the abdomen suspension maneuver and two hours after patients are back in supine position Intra abdominal pressure will be measured thanks to a dedicated nasogastric tube with two balloons (gastric pressure)
Persisting effect of IAP increase in prone position when patients are back in supine position on renal resistive index Two hours after patients are back in supine position RRI measurement will be performed on a right kidney arcuate/interlobar artery, with a high frequency Doppler probe. Three to five consecutive measures will be obtained then RRI computed according to the formula: (peak systolic velocity - end diastolic velocity)/peak systolic velocity).
Persisting effect of IAP increase in prone position when patients are back in supine position on ventilatory mechanics: transpulmonary pressure Two hours after patients are back in supine position transpulmonary pressure will be measured at the end of inspiration and expiration and continuously recorded on a datalogger
Persisting effect of IAP increase in prone position when patients are back in supine position on ventilatory mechanics: driving pressure Two hours after patients are back in supine position driving pressure will be measured at the end of inspiration and expiration and continuously recorded on a datalogger
Persisting effect of IAP increase in prone position when patients are back in supine position on ventilatory mechanics: elastance Two hours after patients are back in supine position elastance will be measured at the end of inspiration and expiration and continuously recorded on a datalogger
Persisting effect of IAP increase in prone position when patients are back in supine position on haematosis Two hours after patients are back in supine position arterial oxygen tension (PaO2) and arterial dioxide carbon tension (PaC02)
Acute kidney injury within 48 hours following prone position According to creatinine or diuresis criteria of Kidney Disease: Improving Global Outcomes (K-DIGO) classification
Trial Locations
- Locations (1)
Hospital Grenoble University
🇫🇷Grenoble, France