Respiratory Function Monitoring of Mechanical Ventilation in Patients With Chest Blunt Injury

Not yet recruiting

• Conditions: Lung Contusion
• Interventions: Other: PEEP setting strategy

• Registration Number: NCT06386120
• Lead Sponsor: Peking University People's Hospital

Brief Summary

The goal of this observational study is to learn about EIT in observing the application of lung protective ventilation strategies in patients with pulmonary contusion, particularly the impact on pulmonary ventilation blood flow ratio, oxygen, and condition. The main question it aims to answer is:

Can lung protective ventilation strategies improve respiratory function in patients with severe chest contusion? We will collect clinical data of participants who already taking lung protective ventilation strategies as part of their regular medical care.

Detailed Description

Trauma is the leading cause of death among middle-aged and young people in China, with over 25% of patients dying from chest trauma. The incidence of pulmonary contusion in severe chest trauma is over 70%, and it is an important cause of respiratory failure and even death in patients. The occurrence of pulmonary contusion and respiratory failure in patients with chest contusion is a dynamic process, and Regional inhomogeneities of the damaged lung should be taken into consideration to develop improved ventilation strategies. Currently, there is no ideal monitoring method to evaluate the severity of injury, and guide the ventilation strategies. Electrical impedance tomography (EIT) is a non-invasive, radiation-free imaging technique. It measures regional lung ventilation and aeration distribution by means of changes in electrical potentials at the skin surface of the chest wall during breathing cycles, which has been proven to have good practicality in patients with non-invasive ARDS and pulmonary embolism. In this study, we aim to characterize the physiologic effects of positive end expiratory pressure (PEEP) on key mechanisms of regional lung protection, namely: recruitment, reduced atelectrauma, and improved ventilation-perfusion matching, by CT scan and EIT

Study Timeline

• Status Verified: 2024-04
• Study First Submitted: 2024-04-24
• Study First Submitted QC: 2024-04-24
• Last Update Submitted: 2024-04-24
• Study First Posted: 2024-04-26
• Last Update Posted: 2024-04-26
• Study Start: 2024-05
• Primary Completion: 2026-05
• Study Completion: 2026-07

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 80

Inclusion Criteria

• Patients with severe chest contusion admitted to the intensive care unit (ICU);
• Abbreviated Injury Scale (AIS) ≥ 3 and/or Blunt Pulmonary Contusion 18 score (BPC18) ≥ 3;
• Age range from 18 to 90 years old;
• Mechanical ventilation;
• Stay in the ICU for less than 12 hours.

Exclusion Criteria

• Perinatal women;
• Expected to be mechanically ventilated for less than 48 h;
• Expected duration of stay in the ICU is less than 24 hours;
• There are contraindications for the use of EIT (pacemaker implantation, local skin wounds after chest surgery, etc.);
• Accept extracorporeal membrane oxygenator;
• Mechanical ventilation>7 days;
• Confirmed ventilator-associated pneumonia;
• Pneumothorax without drainage or presence of subcutaneous emphysema.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
EIT-PEEP group	PEEP setting strategy	The PEEP titration guided by EIT, decided by the responsible attending physician
Table-PEEP group	PEEP setting strategy	The PEEP setting with low FiO2-PEEP table, decided by the responsible attending physician

Primary Outcome Measures

Name	Time	Method
ventilation blood flow ratio	through study completion, an average of 1 year	ventilation blood flow ratio of lung

Secondary Outcome Measures

Name	Time	Method
oxygenation index	through study completion, an average of 1 year	oxygenation index of participant
28-day mortality	through study completion, an average of 1 year	28-day mortality
Mechanical ventilation-free from day 1 to 28	through study completion, an average of 1 year	Mechanical ventilation-free from day 1 to 28
Length of hospital stay	through study completion, an average of 1 year	Length of hospital stay
The rate of successful weaning	through study completion, an average of 1 year	the absence of the requirement for ventilatory support, without reintubation, a cardiac arrest event, or mortality within 48h after extubating or withdrawal
Length of ICU stay	through study completion, an average of 1 year	Length of ICU stay