Evaluation of POC Lung Ultrasound Combined With Pressure-volume Curve to Titration Adjust PEEP for ARDS Lung Recruitment

Study Overview
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Brief Summary
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Using lung ultrasound re-aeration score(LUS-RAS) combined with pressure-volume curve(PVC) adjust maintain positive end-expiratory pressure(PEEP) after recruitment maneuver, to achieve real-time adjustment, reduce ventilation-associated lung injury and the purpose of effective lung recruitment.

Detailed Description
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The traditional method, set PEEP according to PVC in ARDS mechanical ventilation, lacks morphological evaluation. For point-of-care lung ultrasound(POC-LUS) is non-invasive, real-time, visualization, no need transport patients, getting more and more attention in the ARDS treatment. It has been reported that LUS-RAS is a meaningful assessment in recruitment maneuver. This study will combine POC-LUS with PVC in set the initial peep, and then dynamic record LUS-RAS to feedback regulate PEEP. Using the POC-LUS and maximum oxygenation method to assess lung recruitment effect in experimental group and control group prospectively. The ventilator parameters, state of hemodynamic, arterial blood gas(ABG) in each group will be recorded; Statistical methods will be performed in term to understand the correlation.

Official Title
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Clinical Evaluation of Point-of-care Lung Ultrasound Combined With Pressure-volume Curve to Titration Adjust PEEP for ARDS Lung Recruitment

Conditions
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Acute Respiratory Distress Syndrome

Intervention / Treatment
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* Device: Lung Ultrasound
* Diagnostic Test: Maximum Oxygenation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patient aged 18 years and older ARDS patients with invasive mechanical ventilation Exclusion Criteria: Intracranial hypertension Pneumothorax and mediastinal emphysema Severe hypoxemia (oxygenation index <100) Hemodynamic instability Chest deformity or surgical history Affect Lung-ultrasound conditions: subcutaneous emphysema, chest wound etc.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Maximum Oxygenation<br>Using PVC to set the initial peep, check ABG real-time, and according to PaO2+PaCO2≥400mmHg whether or not to adjust maintain PEEP. | Diagnostic Test: Maximum Oxygenation<br>* Adjust PEEP real-time in term of PaO2+PaCO2≥400mmHg whether or not.<br>|
| Experimental: Lung Ultrasound Re-aeration Score<br>Combine POC-LUS with PVC in set the initial peep, and then dynamic record LUS-RAS to feedback regulate PEEP. | Device: Lung Ultrasound<br>* Adjust PEEP real-time in term of LUS-RAS chang.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lung Ultrasound re-aeration score, LUS-RAS | The score is composed of 12 different regions of chest wall checked by POC-LUS. | 48 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute respiratory distress syndrome, ARDS, Point-of-care lung ultrasound,POC-LUS, Pressure-volume curve, PVC, Positive end-expiratory pressure, PEEP, Ultrasound re-aeration score, US-RAS