Driving Pressure in Trauma

Completed

• Conditions: Sever Chest Trauma; Mechanical Ventilation

• Registration Number: NCT03367442
• Lead Sponsor: University Hospital, Montpellier

Brief Summary

Traumatic chest injuries are responsible for significant morbidity and the cause of trauma-related death in 20%-25% of cases. Thoracic trauma can include multiple injuries, mainly osseous (ribs, sternal fractures, flail chest), pulmonary contusions or lacerations, pneumothoraces and pleural effusions, and sometimes involve wounds to the heart and vessels (aortic dissection, cardiac contusion) or diaphragm. Following trauma, patients with thoracic injuries are at risk of developing acute respiratory distress syndrome (ARDS). This worsening of respiratory function can lead to requirement for mechanical ventilation. In addition, changes to gas exchange may also be generated or aggravated by mechanical ventilation as a result of barotrauma, biotrauma, or ventilation-associated pneumonia. Many mechanical ventilation strategies have been tried in trauma patients in the last 30 years to determine the optimal method of maximizing gas exchange with minimal lung damage. The driving pressure of the respiratory system has been shown to strongly correlate with mortality in a recent large retrospective ARDSnet study. Respiratory system driving pressure \[plateau pressure-positive end-expiratory pressure (PEEP)\] does not account for variable chest wall compliance especially in cases of chest trauma. Esophageal manometry can be utilized to determine transpulmonary driving pressure. A recent study suggests that utilizing PEEP titration to target positive transpulmonary pressure via esophageal manometry causes both improved elastance and driving pressures. Treatment strategies leading to decreased respiratory system and transpulmonary driving pressure at 24 h may be associated with improved 28 day mortality. However, currently no specific study with chest trauma patients exists. We propose to investigate the effect of hight transpulmonary driving pressure on duration on mechanical ventilation, length of stay and mortality in patients with sever chest trauma.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2017-12-04
• Study First Submitted QC: 2017-12-07
• Study First Posted: 2017-12-08
• Study Start: 2018-11-22
• Status Verified: 2022-09
• Primary Completion: 2022-09-15
• Study Completion: 2022-09-15
• Last Update Submitted: 2022-09-27
• Last Update Posted: 2022-09-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

• Major patients (18-90 years old)
• Affiliated to the social security
• Hospitalized following severe trauma chest trauma
• Mechanical ventilatory support for a minimum of 72 hours

Exclusion criteria:

• Minor patients,
• Patients under tutorship / curatorship,
• Pregnant or lactating women

Exclusion Criteria

Not provided

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Duration of mechanical Ventilation	1 day	Duration of mechanical Ventilation

Secondary Outcome Measures

Name	Time	Method
Mortality	1 day	Mortality
Pulmonary compliance	1 day	Pulmonary compliance
Pulmonary stress and strain	1 day	Pulmonary stress and strain
During of SDRA	1 day	During of SDRA
Length of stay in intensive care unit	1 day	Length of stay in intensive care unit

Trial Locations

Locations (1)

Uhmontpellier; 🇫🇷 Montpellier, France