Pediatric Positive End Expiratory Pressure (PEEP) Titration Using Electrical Impedence Tomography (EIT)
Assessing Optimal Positive End-expiratory Pressure (PEEP) Using Electrical Impedance Tomography (EIT) During a PEEP Titration Protocol in Mechanically Ventilated Children with Pediatric Acute Respiratory Distress Syndrome (PARDS)
Children's Hospital Los Angeles
60 participants
Dec 10, 2024
INTERVENTIONAL
Conditions
Summary
The goal of this clinical trial is to perform a PEEP titration protocol and use EIT to identify the optimal PEEP at which lung overdistention and collapse are most effectively balanced. The primary and secondary aims of the study are as follows: Identify the difference between the optimal PEEP recommended by EIT metrics and the current guideline recommended approach to identifying optimal PEEP in PARDS. There will be a statistically significant difference in the recommended optimal PEEP identified using the EIT PEEP titration tool and that of the PEEP/FiO2 grid recommendations. Determine the difference in physiologic metrics between EIT optimal PEEP and the PEEP/FiO2 recommended PEEP. Participants will undergoing EIT monitoring while being subjected to PEEP titration protocol.
Eligibility
Inclusion Criteria4
- Any person who is less than 18 years of age
- is on invasive mechanical ventilation
- is not spontaneously breathing
- meets PARDS criteria
Exclusion Criteria11
- Contraindication to the use of EIT
- Hemodynamic instability
- Contraindications to hypercapnia
- patients with uncuffed endotracheal or tracheostomy tubes
- diagnosis of pneumothorax or bronchopleural fistula
- non-conventional ventilation
- any patient on extra-corporeal membrane oxygenation (ECMO) support
- less than 1 week post-operatively from cardiac surgery
- the following cardiac diagnoses: Glenn or Fontan physiology, significant right to left shunt
- Corrected Gestational Age < 37 weeks
- pregnancy
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Interventions
A PEEP titration will occur for the patient with the PEEP increased by 2 cm H2O every 2 minutes until a maximum PEEP of 20 or three steps (+ 6 cm H2O) above the set clinical PEEP. The PEEP will then be decreased by 2 cmH2O every 2 minutes until a minimum PEEP of 6 cmH2O or three steps (- 6 cm H2O) below their clinical PEEP.
Locations(1)
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NCT06684119