Driving Pressure in Trauma

NCT03367442 | Completed

• 1 other identifier: RECHMPL17_0354
• Study Type: observational
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

Traumatic chest injuries are responsible for significant morbidity and the cause of trauma-related death in 20%-25% of cases. Thoracic trauma can include multiple injuries, mainly osseous (ribs, sternal fractures, flail chest), pulmonary contusions or lacerations, pneumothoraces and pleural effusions, and sometimes involve wounds to the heart and vessels (aortic dissection, cardiac contusion) or diaphragm. Following trauma, patients with thoracic injuries are at risk of developing acute respiratory distress syndrome (ARDS). This worsening of respiratory function can lead to requirement for mechanical ventilation. In addition, changes to gas exchange may also be generated or aggravated by mechanical ventilation as a result of barotrauma, biotrauma, or ventilation-associated pneumonia. Many mechanical ventilation strategies have been tried in trauma patients in the last 30 years to determine the optimal method of maximizing gas exchange with minimal lung damage. The driving pressure of the respiratory system has been shown to strongly correlate with mortality in a recent large retrospective ARDSnet study. Respiratory system driving pressure \[plateau pressure-positive end-expiratory pressure (PEEP)\] does not account for variable chest wall compliance especially in cases of chest trauma. Esophageal manometry can be utilized to determine transpulmonary driving pressure. A recent study suggests that utilizing PEEP titration to target positive transpulmonary pressure via esophageal manometry causes both improved elastance and driving pressures. Treatment strategies leading to decreased respiratory system and transpulmonary driving pressure at 24 h may be associated with improved 28 day mortality. However, currently no specific study with chest trauma patients exists. We propose to investigate the effect of hight transpulmonary driving pressure on duration on mechanical ventilation, length of stay and mortality in patients with sever chest trauma.

Conditions

Sever Chest Trauma; Mechanical Ventilation

Keywords

Thoracic trauma; mechanical ventilation; Acute respiratory distress syndrome; Esophageal pressure; Pleural pressure

Outcome Measures

Primary Outcomes (1)

• Duration of mechanical Ventilation

  Duration of mechanical Ventilation

  1 day

Secondary Outcomes (5)

• During of SDRA

  1 day

• Length of stay in intensive care unit

  1 day

• Mortality

  1 day

• Pulmonary compliance

  1 day

• Pulmonary stress and strain

  1 day

Interventions

no intervention OTHER

no intervention

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Patients with sever chest trauma under mechanical ventilation

You may qualify if:

• Major patients (18-90 years old)
• Affiliated to the social security
• Hospitalized following severe trauma chest trauma
• Mechanical ventilatory support for a minimum of 72 hours

You may not qualify if:

• Minor patients,
• Patients under tutorship / curatorship,
• Pregnant or lactating women

Sponsors & Collaborators

• University Hospital, Montpellier: lead

Study Sites (1)

Uhmontpellier

Montpellier, 34295, France

Location

MeSH Terms

Conditions

Respiratory Distress Syndrome

Condition Hierarchy (Ancestors)

Lung Diseases; Respiratory Tract Diseases; Respiration Disorders

Study Officials

• Jonathan CHARBIT, MD

  University Hospital, Montpellier

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 4, 2017
• First Posted: December 8, 2017
• Study Start: November 22, 2018
• Primary Completion: September 15, 2022
• Study Completion: September 15, 2022
• Last Updated: September 28, 2022

Record last verified: 2022-09

Locations

FR (1)