RecruitingNot ApplicableNCT06647784

Lateral Positioning and Prone Positioning in ARDS Patients

Effect of Lateralization Before and During Prone Position on Pulmonary Aeration During ARDS

Sponsor

Centre Hospitalier de Bastia

Enrollment

20 participants

Start Date

Nov 26, 2024

Study Type

INTERVENTIONAL

Conditions

ARDS

Summary

Lateral (30°) and alternating positioning (change of side every 30 minutes) carried out on specific beds, could be an alternative or complement to prone positioning (PP) in ARDS patients. The combination of lateralization in prone position has not been studied. The dynamic created by lateralization could allow better overall ventilation during PP, thus making it possible to further improve oxygenation. The main objective of this prospective, bicentric, open, single group study with repeated measures will be to demonstrate that the addition of repeated 30-minute periods of 30° lateralization improves pulmonary aeration in the supine and prone positions in patients with moderate to severe ARDS.

Eligibility

Min Age: 18 Years

Inclusion Criteria22

Age of at least 18 years
ARDS evolving for less than 5 days with a PaO2/FiO2 ratio (P/F ratio) < 150 after optimization of PEEP (P/V curve, R/I ratio), curarization and without prior use of the PP since orotracheal intubation.
Obtained written consent of the patient, one of his relatives or the previously designated trusted person. As soon as possible, the patient will be informed and his written consent will be obtained
Beneficiary of health insurance coverage
Possibility of participating in any other studies whose evaluation criteria do not interfere with those of the study
Patients with at least one of the following criteria will not be eligible:
Refusal to participate
Pregnant, parturient or breastfeeding women
Intracranial pressure > 30 mm Hg or cerebral perfusion pressure < 60 mmHg
Severe chronic respiratory disease with oxygen therapy or mechanical ventilation at home (except CPAP/BIPAP for obstructive sleep apnea)
Chronic interstitial lung diseases
Patients on ECMO
Weight > 100 kg
Severe liver disease Child-Pugh score 12-15
Pneumothorax
SAPS II score > 75 at inclusion
Unstable spinal fracture
Contraindications to EIT (pacemaker, implantable defibrillator, skin lesions between the 4th and 5th ribs).
Withdrawal (except for ECMO) or witholding treatment decision
Any other reason which, according to the investigator, could interfere with the evaluation of the study objectives
Person under legal protection measure (guardianship, curatorship, etc.)
Person deprived of liberty by a judiciary or administrative decision

Exclusion Criteria1

\- Patients who will be unable to complete the 25-hour intervention due to worsening requiring ECMO, death or organizational problems will be excluded from the analysis.

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Interventions

OTHERpulmonary aeration in supine and ventral decubitus

The addition of repeated periods of 30 minutes of lateralization of 30° amplitude in dorsal decubitus and in ventral decubitus in patients with moderate to severe ARDS. Included patients will benefit from sessions of lateral decubitus for 30 minutes on each side (with an inclination of 30°) with alternation right/left (total one hour). During this period, the upper part of the bed will be inclined by 30°. Patients will then be positioned in strict prone position for a period of 6 hours after which, the same pattern of alternating lateral decubitus will be applied for 12 hours while the patient is still in the prone position. After reversal in supine position, an observation period of 1 hour will be respected before carrying out the last measurements. The total duration of the intervention will be 20 hours.