Effect of PEEP on Lung Recruitment and Homogeneity Over Time in Moderate to Severe ARDS (APRV)
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|ClinicalTrials.gov Identifier: NCT03140579|
Recruitment Status : Not yet recruiting
First Posted : May 4, 2017
Last Update Posted : January 5, 2018
This study evaluates the effect of airway pressure release ventilation (APRV) on lung homogeneity and recruitment in patients with moderate to severe acute respiratory distress syndrome (ARDS).
It will do this by comparing the homogeneity of ventilation and recruitment prior to a patient being ventilated on APRV, and at 30, 60 and 120 minutes after starting APRV.
|Condition or disease||Intervention/treatment|
|ARDS Critical Illness Ventilator-Induced Lung Injury||Other: APRV|
Ventilator-induced lung injury (VILI) is a well-recognised problem of ventilation in patients with ARDS, and is currently treated with lung-protective ventilation, which limits tidal volumes and airway pressures by applying higher levels of positive-end expiratory pressure (PEEP). However, it is not known whether higher levels of PEEP increases recruitment and homogeneity of ventilation within the lungs.
APRV is a mode of inverse ventilation, where high levels of PEEP are maintained with brief releases of pressure, and has been proposed as an appropriate method of ventilation in patients with ARDS.
This study will assess homogeneity of ventilation and recruitment in 15 patients before APRV is started, and 30, 60 and 120 mins after commencing APRV. It will do this using Electrical Impedance Tomography (EIT), nitrogen wash in/wash out technique, and lung strain.
|Study Type :||Observational|
|Estimated Enrollment :||15 participants|
|Official Title:||Estimation of Long Term PEEP Effect on Lung Homogeneity and Recruitment Using APRV Ventilation:Measurement of End Expiratory Lung Volume With Nitrogen Wash-out/wash-in Technique and End Expiratory Lung Impedance With EIT at Different Times.|
|Estimated Study Start Date :||June 1, 2018|
|Estimated Primary Completion Date :||December 31, 2018|
|Estimated Study Completion Date :||December 31, 2018|
- Other: APRV
Airway pressure release ventilation is a method of inverse ventilation, where high levels of positive end expiratory pressure are maintained to optimise oxygenation with brief releases of pressure to allow ventilation and release carbon dioxide. It is an approved and frequently used method of ventilation.
- To compare lung homogeneity estimated with EIT upon commencing APRV (APRVpre) and after 30 - 60 - 120 min of APRV ventilation (APRV30, APRV60, APRV120) in patients with moderate to severe ARDS [ Time Frame: 30, 60 and 120 mins ]EIT will be measured at time APRVpre during a "low-flow maneuver" consisting of a brief switch to PC ventilation: with a flow of 4 L/min, airway pressure will be gradually increased up to 30 cmH20 in order to see how the lung changes elastically minimising resistance. EIT will also be measured after 30 min (time APRV30), 60 min (time APRV60), 120 min (time APRV120) since APRV has started.
- To assess recruitment at the beginning and after the end of APRV ventilation in patients with moderate-severe ARDS. [ Time Frame: 2 hours ]To assess recruitment measuring change in end expiratory lung impedance (EELI) with EIT technique, and EELV with nitrogen wash-out/wash-in technique.
- To compare lung strain measured at APRVpre and after the end of APRV ventilation (APRVpost) in patients with moderate-severe ARDS [ Time Frame: 2 hours ]Strain will be calculated at time APRVpre using the strain formula (TV/EELV)
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03140579
|Contact: Gill Arbane||02071887188 ext firstname.lastname@example.org|
|Contact: Luigi Camporota||02071887188||Luigi.Camporota@gstt.nhs.uk|
|Guys and St Thomas NHS Foundation||Not yet recruiting|
|London, United Kingdom, SE1 7EH|
|Contact: Gill Arbane 02071887070 email@example.com|
|Principal Investigator:||Luigi Camporota||Guy's and St Thomas' NHS Foundation Trust|