Effects of Trunk Postural Change on CO2 Removal Efficiency in ARDS Patients: Quasi-experimental Study

NCT05281536 | Completed

• 1 other identifier: E012021
• Study Type: interventional
• Target: 22
• Locations: 1 country
• Sites: 2

Brief Summary

OBJECTIVES: The trunk inclination from semirecumbent to lying supine improves lung mechanics and reduces end-expiratory lung volume in Acute Respiratory Distress Syndrome (ARDS) patients. Besides, it can improve the ventilatory ratio and PaCO2, although the effects and mechanisms are not entirely elucidated. Therefore, this study aimed to evaluate the effects of trunk tilt from 45° to 10° on CO2 removal efficiency. DESIGN: Quasi-experimental study. SETTING: A medical ICU in Chile. PATIENTS: Twenty-two patients with ARDS. INTERVENTION: Patients in pressure-controlled ventilation underwent three 60-minute steps in which trunk inclination was changed from 45° (baseline) to 10° (intervention) and back to 45° (control) in the last step. Respiratory mechanics, arterial blood gas analysis, dead space by volumetric capnography, and electrical impedance tomography were recorded.

Conditions

ARDS

Keywords

Trunk Inclination; Postural change; Dead space; ARDS

Outcome Measures

Primary Outcomes (2)

• Changes in PaCO2

  Determine the effects of postural changes from 45° to 10° on PaCO2

  60 minutes each phase

• Changes in Bohr's dead-space

  Determine the effects of postural changes from 45° to 10° on Bohr's dead-space

  60 minutes each phase

Study Arms (1)

Postural Changes from 45° to 10° in supine decubitus

EXPERIMENTAL

Postural changes from 45° to 10° in supine decubitus Three times of 60 minutes each step before (45°, baseline) - during (10°, intervention) - after (45°, control)

Other: Ppostural change from 45° to 10° in supine position

Interventions

Ppostural change from 45° to 10° in supine position OTHER

The intervention will be a postural change from 45° to 10° in a semi-recumbent position of ARDS patients connected to mechanical ventilation.

Postural Changes from 45° to 10° in supine decubitus

Eligibility Criteria

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

You may qualify if:

• Over 18 years old
• Admitted to Intensive Care with mild, moderate, or severe ARDS according to the Berlin classification
• Less than 72 hours of connection to mechanical ventilation.
• Depth Sedation-analgesia.
• Acceptance by the legal representative to participate in the study.

You may not qualify if:

• Pleural tube - bronchopulmonary fistula.
• Prone position
• Hypovolemic shock with active bleeding.
• Intracranial hypertension.
• Gastric residue greater than 300 ml in the last 6 hours
• Hemodynamic instability that requires a progressive increase in the dose of vasopressors
• Temperature variations greater than 0.5 ° C in the last 2 hours
• Acute heart failure
• Chronic respiratory disease (FEV1 \<50% predicted).
• Patients who do not have an arterial line.

Sponsors & Collaborators

• Clinica las Condes, Chile: lead

Study Sites (2)

Clínica Las Condes

Santiago, Santiago Metropolitan, 13114, Chile

Location

Martín Hernán Benites

Santiago, Santiago Metropolitan, 7550000, Chile

Location

Related Publications (4)

• Marrazzo F, Spina S, Forlini C, Guarnieri M, Giudici R, Bassi G, Bastia L, Bottiroli M, Fumagalli R, Langer T. Effects of Trunk Inclination on Respiratory Mechanics in Patients with COVID-19-associated Acute Respiratory Distress Syndrome: Let's Always Report the Angle! Am J Respir Crit Care Med. 2022 Mar 1;205(5):582-584. doi: 10.1164/rccm.202110-2360LE. No abstract available.

  PMID: 34982652 BACKGROUND

• Tusman G, Gogniat E, Bohm SH, Scandurra A, Suarez-Sipmann F, Torroba A, Casella F, Giannasi S, Roman ES. Reference values for volumetric capnography-derived non-invasive parameters in healthy individuals. J Clin Monit Comput. 2013 Jun;27(3):281-8. doi: 10.1007/s10877-013-9433-x. Epub 2013 Feb 7.

  PMID: 23389294 RESULT

• Mentzelopoulos SD, Roussos C, Zakynthinos SG. Static pressure volume curves and body posture in acute respiratory failure. Intensive Care Med. 2005 Dec;31(12):1683-92. doi: 10.1007/s00134-005-2838-3. Epub 2005 Oct 26.

  PMID: 16249926 RESULT

• Rehder K. Postural changes in respiratory function. Acta Anaesthesiol Scand Suppl. 1998;113:13-6. doi: 10.1111/j.1399-6576.1998.tb04980.x.

  PMID: 9932113 RESULT

MeSH Terms

Interventions

Supine Position

Intervention Hierarchy (Ancestors)

Posture; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Martín Benites, MD

  Clínica Las Condes

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Masking Details: Data obtained for mechanical ventilation, volumetric capnography, and electric impedance tomography will be download by different investigators when all patients have been recruited. The results will be analyzed by statisticians, who will not know the participant's identification
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The intervention will be a postural change from 45° to 10° in a semi-recumbent position of ARDS patients connected to mechanical ventilation.

Study Record Dates

• First Submitted: March 7, 2022
• First Posted: March 16, 2022
• Study Start: April 1, 2021
• Primary Completion: September 30, 2022
• Study Completion: September 30, 2022
• Last Updated: November 17, 2022

Record last verified: 2022-11

Data Sharing

• IPD Sharing: Will not share

Locations

CL (2)