Ignite Creation Date:
2024-05-06 @ 1:12 PM
Last Modification Date:
2024-10-26 @ 1:11 PM
Study NCT ID:
NCT03969407
Status:
COMPLETED
Last Update Posted:
2020-01-23
First Post:
2019-05-29
Brief Title:
Determination of the Best Positive End-expiratory Pressure PEEP
Sponsor:
Centre Chirurgical Marie Lannelongue
Organization:
Centre Chirurgical Marie Lannelongue
Study Overview
Official Title:
Determination of the Best Positive End-expiratory Pressure PEEP Based on Oxygenation or Driving Pressure in Patients With Acute Respiratory Distress Syndrome After Cardiac Thoracic Surgery
Status:
COMPLETED
Status Verified Date:
2019-05
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
DROP
Brief Summary:
Determination of the best positive end-expiratory pressure PEEP based on oxygenation or driving pressure in patients with acute respiratory distress syndrome ARDS after cardiothoracic surgery
The use of a positive end-expiratory pressure in acute respiratory distress syndrome is obvious in ARDS management On the one hand it serves to fight against the reduction of functional residual capacity FRC and enable the limitation of hypoxia and on the other hand it allows the limitation of openingclosing lesions in pulmonary alveoli which lead to increase bio trauma
However elevated PEEP has harmful effect such as hemodynamic effect on the right ventricle and distension on healthy part of the lungOther adverse effects are decreasing cardiac output increased risk of barotrauma and the interference with assessment of hemodynamic pressures
Ideally the adjustment of PEEP level must be done by taking into account each patient characteristic PEEP titration based on blood gas analysis is one of the most used techniques by physicians
Current guidelines for lung-protective ventilation in patients with acute respiratory distress syndrome ARDS suggest the use of low tidal volumes Vt set according to ideal body weight IBW of the patient and higher levels of positive end-expiratory pressure PEEP to limit ventilator-induced lung injury VILI However recent studies have shown that ARDS patients who are ventilated according to these guidelines may still be exposed to forces that can induce or aggravate lung injury
Driving pressure DP is the difference between the airway pressure at the end of inspiration plateau pressure Ppl and PEEP
Driving pressure may be a valuable tool to set PEEP Independent of the strategy used to titrate PEEP changes in PEEP levels should consider the impact on driving pressure besides other variables such as gas exchange and hemodynamics A decrease in driving pressure after increasing PEEP will necessarily reflect recruitment and a decrease in cyclic strain On the contrary an increase in driving pressure will suggest a non-recruitable lung in which overdistension prevails over recruitment
The main purposes of this study are to assess the optimal PEEP based on the best driving pressure or the best oxygenation
The use of a positive end-expiratory pressure in acute respiratory distress syndrome is obvious in ARDS management On the one hand it serves to fight against the reduction of functional residual capacity FRC and enable the limitation of hypoxia and on the other hand it allows the limitation of openingclosing lesions in pulmonary alveoli which lead to increase bio trauma
However elevated PEEP has harmful effect such as hemodynamic effect on the right ventricle and distension on healthy part of the lungOther adverse effects are decreasing cardiac output increased risk of barotrauma and the interference with assessment of hemodynamic pressures
Ideally the adjustment of PEEP level must be done by taking into account each patient characteristic PEEP titration based on blood gas analysis is one of the most used techniques by physicians
Current guidelines for lung-protective ventilation in patients with acute respiratory distress syndrome ARDS suggest the use of low tidal volumes Vt set according to ideal body weight IBW of the patient and higher levels of positive end-expiratory pressure PEEP to limit ventilator-induced lung injury VILI However recent studies have shown that ARDS patients who are ventilated according to these guidelines may still be exposed to forces that can induce or aggravate lung injury
Driving pressure DP is the difference between the airway pressure at the end of inspiration plateau pressure Ppl and PEEP
Driving pressure may be a valuable tool to set PEEP Independent of the strategy used to titrate PEEP changes in PEEP levels should consider the impact on driving pressure besides other variables such as gas exchange and hemodynamics A decrease in driving pressure after increasing PEEP will necessarily reflect recruitment and a decrease in cyclic strain On the contrary an increase in driving pressure will suggest a non-recruitable lung in which overdistension prevails over recruitment
The main purposes of this study are to assess the optimal PEEP based on the best driving pressure or the best oxygenation
Detailed Description:
None
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None