An Evaluation of End-Expiratory Lung Volume and Pulmonary Mechanics With Different PEEP Levels in Mechanical Ventilation in ARDS Patients

NCT05993780 | Completed

• 1 other identifier: PamukkaleUSyuksel-001
• Study Type: interventional
• Target: 14
• Locations: 1 country
• Sites: 1

Brief Summary

ARDS management is quite complex, and mortality is high. PEEP titration is very important in mechanical ventilation. However, the most appropriate approach for PEEP titration has yet to be determined. Currently, the emphasis is on focused PEEP implementation. The present study aimed to evaluate the volume gain at different PEEP levels over the pressure-volume curve, the changes in EELV measured by the modified multiple nitrogen wash-out/wash-in technique, and the compliance with respiratory mechanics. 14 adult ARDS patients undergoing invasive mechanical ventilation were included in the study. According to the Berlin Criteria, There were two mild, seven moderates, and five severe ARDS patients. FRC and EELV with decreased PEEP titration estimates (5 cmH2O) were measured by the multiple nitrogen wash-out/washin technique. Gain and compliance values were measured over the dynamic pressure-volume curves created by the intracheal pressure sensor.

Conditions

Ards

Outcome Measures

Primary Outcomes (1)

• Does volume gain indicate recruited lung volume?

  A dynamic compliance curve was generated during the analysis, and volume changes in this curve were determined at each PEEP level. The difference in EELV at two different PEEP levels during a descending PEEP trial was calculated as ∆EELV, and the difference between ∆EELV and the volume derived from the pressure-volume curve was calculated as "volume gain" (gain = ∆EELV - volume derived from the curve). The estimated lung volume recovered was calculated using the formula ∆EELV - (∆PEEP x Compliance PEEPlow) and compared with the volume gain.

  Patients were ventilated for 10 minutes at each PEEP level.Measurement was taken after 10 minutes.]

Secondary Outcomes (4)

• Static compliance correlation with volume gain.

  Patients were ventilated for 10 minutes at each PEEP level.Measurement was taken after 10 minutes.

• Calculation of respiratory system elastance and its correlation with volume gain.

  Patients were ventilated for 10 minutes at each PEEP level.Measurement was taken after 10 minutes.

• Examination of the relationship between static strain and volume gain.

  Patients were ventilated for 10 minutes at each PEEP level.Measurement was taken after 10 minutes.

• Investigation of the correlation between driving pressure and volume gain

  Patients were ventilated for 10 minutes at each PEEP level.Measurement was taken after 10 minutes.

Other Outcomes (2)

• Hemodynamic parameters of patient with ARDS were measured during different PEEP measurement.

  Measurements were taken after 10 minutes of ventilating at the PEEP level.

• Arterial blood gas analysis

  Measurements were taken after 10 minutes of ventilating at the PEEP level.

Study Arms (1)

ARDS patient

OTHER

14 patients with ARDS were included in the study. It was planned as a single group.

Other: No drugs or biologial agents were used in our trial

Interventions

No drugs or biologial agents were used in our trial OTHER

Before the measurement, a recruitment maneuver was performed for 30-40 s at a PEEP level of 20 cmH2O. At four different PEEP levels of 15, 10, 5, and 0 cmH2O, a decreasing PEEP trial was performed, and the measurement results were recorded.The measurement time at each PEEP level was chosen as 10 minutes. At the end of the measurement, static compliance was measured by applying an end-inspiratory pause. Respiratory system elastance,static strain volume gain was calculated.The estimated lung volume recovered was calculated using the formula ∆EELV - (∆PEEP x Compliance PEEPlow) and compared with the volume gain.

ARDS patient

Eligibility Criteria

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

You may qualify if:

• Patients diagnosed with ARDS according to the Berlin criteria
• Berlin definition criteria: (1) presence of acute hypoxemic respiratory failure, (2) onset within 7 days of insult, or or new (within 7 days) or worsening respiratory symptoms; (3) bilateral opacities on chest x-ray or CT not fully explained by effusions, lobar or lung collapse, or nodules; and (4) cardiac failure not primary cause of acute respiratory failure.

You may not qualify if:

• Patients with severe cardiovascular instability (Mean arterial pressure \<60 mmHg , Pulse \<45 or \>150), Patients with pneumothorax, Patients who have undergone pneumonectomy operation, Patients with Lung Transplantation, Patients with thoracic deformity, ARDS patients with cor pulmonale

Sponsors & Collaborators

• Pamukkale University: lead

Study Sites (1)

Pamukkale University

Denizli, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Acute Lung Injury

Condition Hierarchy (Ancestors)

Lung Injury; Lung Diseases; Respiratory Tract Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Specialist, Department of Anesthesiology and Reanimation, MD

Study Record Dates

• First Submitted: July 31, 2023
• First Posted: August 15, 2023
• Study Start: August 2, 2021
• Primary Completion: August 26, 2021
• Study Completion: August 26, 2021
• Last Updated: August 15, 2023

Record last verified: 2023-08

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)