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RecruitingNot ApplicableNCT05717218

Ultra-protective Ventilation Monitored by Electrical Impedance Tomography in Patients With Severe Acute Respiratory Distress Syndrome on Veno-venous ECMO

Sponsor

Assistance Publique - Hôpitaux de Paris

Enrollment

50 participants

Start Date

Mar 11, 2023

Study Type

INTERVENTIONAL

Conditions

Severe ARDS

Summary

For ECMO supported patients with severe ARDS (acute respiratory distress syndrome), usual care include use of "ultraprotective" mechanical ventilation with tidal volume and pressure reductions that might ultimately enhance lung protection of patients with ARDS. Although very low tidal might also cause pulmonary derecruitment. The aim of this study is to monitor effects of very low tidal volume on regression of overdistension and derecruitment using electrical impedance tomography. Secondary aim is to describe the evolution of the optimal PEEP (Positive End Expiratory Pressure) during the decrease of the tidal volume

Eligibility

Min Age: 18 Years

Inclusion Criteria4

  • aged ≥ 18 years
  • patient with ARDS on venovenous (VV)-ECMO
  • Written informed consent
  • patient affiliated to a social security scheme

Exclusion Criteria6

  • Pregnancy
  • Adult patient subject to a legal protection measure (tutor, curator, etc.)
  • Patients with a pacemaker, automatic implantable cardioverter defibrillator,
  • contraindications to thoracic belt placement (e.g., thoracic or spinal cord trauma, recent thoracic surgery)
  • undrained pneumothorax, bronchopleural fistula
  • hemodynamic instability (i.e., use of intravenous fluids of more than 10 mL/kg or vasopressors 2 mg/h of norepinephrine or 0.5 mg/h of epinephrine)

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Interventions

DEVICEUltra-protective mechanical ventilation monitored by electrical impedance tomography

A silicone EIT belt will be placed around the patient's thorax (sixth intercostal parasternal space). EIT data will be generated by application of a small alternating electrical current (5 mA at 50 kHz). Introduction of "ultraprotective" mechanical ventilation will be monitored.

Locations(1)

Service de médecine intensive - réanimation Hopital Pitié Salpêtrière

Paris, France

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NCT05717218