Open Lung Strategy in Critically Ill Morbid Obese Patients Lung Imaging and Heart-lung Interaction
试验速览
- 阶段
- 不适用
- 入组人数
- 21
- 试验地点
- 2
- 主要终点
- Respiratory System Elastance
研究概览
简要总结
The goal of this interventional crossover study in morbidly obese intubated and mechanically ventilated patients is to describe the respiratory mechanics and the heart-lung interaction at titrated positive end-expiratory pressure levels following a recruitment maneuver with transthoracic echocardiography and electric impedance tomography imaging.
详细描述
Obese patients under mechanical ventilation are more likely to develop atelectasis as a consequence of the increased abdominal weight. Atelectasis is the primary responsible for respiratory insufficiency and impossibility to wean obese patients from respiratory support.
In a previous study we demonstrated the efficacy of the application of titrated PEEP levels following a recruitment maneuver in obese patients, i.e. improvement in respiratory mechanics and gas exchanges without negative hemodynamic effects.
The application of lung and heat imaging will allow us to quantitatively describe:
- Increase in aerated lung tissue (reduction of atelectasis)
- Reduction of over-inflation of the ventilated regions
- Recoupling of ventilation and perfusion
- Improvement in right heart function by reduction of right heart afterload
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 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
- •ICU admitted requiring intubation and mechanical ventilation
- •BMI ≥ 35 kg/m2
- •Waist circumference > 88 cm (for women)
- •Waist circumference > 102 cm (for men)
排除标准
- •Known presence of esophageal varices
- •Recent esophageal trauma or surgery
- •Severe thrombocytopenia (Platelets count ≤ 5,000/mm3)
- •Severe coagulopathy (INR ≥ 4)
- •Presence or history of pneumothorax
- •Pregnancy
- •Patients with poor oxygenation index (PaO2/FiO2< 100 mmHg with at least 10 cmH2O of PEEP)
- •Pacemaker and/or internal cardiac defibrillator
- •Hemodynamic parameters: systolic blood pressure (SBP) <100 mmHg and >180 mmHg, or if SBP is between 100-180 mmHg on high dose of IV continuous infusion norepinephrine (>20 μg per minute), or dobutamine (>10 μg per minute), or dopamine (>10 μg per Kg per minute), or epinephrine (>10 μg per minute).
结局指标
主要结局
Respiratory System Elastance
时间窗: During study time points :baseline, PEEP incremental, PEEP decremental
Difference in Respiratory System Elastance measured in cmH2O/L
次要结局
- Lung mechanics - Compliance(Study time points: baseline, PEEP incremental, PEEP decremental)
- Lung mechanics - Airway resistances(During study time points: baseline, PEEP incremental, PEEP decremental)
- Survival(28 days after the performance of the study protocol)
研究者
Robert M. Kacmarek
RRT, PhD
Massachusetts General Hospital