Strain and Blood Inflammatory Markers as Prognostic Tools for ARDS AMIS (ARDS - Markers of Inflammation - Strain)

Study Overview
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Brief Summary
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The objective is determine the strain measured at the bedside could be a dynamic prognostic marker of during Acute respiratory Distress Syndrome (ARDS).

Detailed Description
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Nowadays ARDS severity, and therapeutic efficiency are evaluated using PaO2/FiO2 ratio. Inflammation is a cornerstone of ARDS and the ratio is not a sufficiently accurate tool to predict the evolution of ARDS. A reproducible marker would be helpful to adapt the therapeutics and maybe limit their deleterious effects. The investigators made the hypothesis that patients moderate to severe ARDS (comparable PaO2/FiO2 ratio) with a higher strain may have higher inflammation. Moderate/severe ARDS will be ventilate with protective ventilation (low tidal volume and PEEP set to limit plateau pressure under 30cmH2O). Markers of inflammation will be measured in the broncho Alveolar Lavage the first day and in the blood the following days. Strain will be measured at the bedside using the nitrogen washout-washin. Markers of inflammation and strain will be analysed with ventilatory and oxygenation.

Official Title
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Strain and Blood Inflammatory Markers as Prognostic Tools for ARDS AMIS (ARDS - Markers of Inflammation - Strain)

Conditions
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Acute Respiratory Distress Syndrome

Intervention / Treatment
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* Other: Inflammatory markers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Moderate to severe ARDS (Berlin Definition) Acute beginning <1 week PaO2/FiO2 ratio ≤ 200 after 24h mechanical ventilation with PEEP≥5cmH2O Bilateral opacities on chest X-ray Respiratory failure not fully explain by cardiac failure or fluid overload Informed consent signed by the next of kin and secondarily by the patient when awake Patient with social insurance No Inclusion criteria Age < 18 Pregnancy a pregnancy test will be done to women of childbearing age Chronic obstructive pulmonary disease Severe hypoxemia PaO2/FiO2 <50% with high PEEP Immunosuppressive treatment Immunodeficiency onco-hematology, HIV

Ages Eligible for Study
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Minimum Age: 18 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: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Inflammatory markers<br>All patients with inclusion criteria (ARDS moderate and severe: Berlin definition) and absence of non inclusion criteria will have a broncho alveolar wash at day 0 and blood sample every three day to measure inflammatory markers. All patients will receive protective ventilation with low tidal volume and pressures limited (Pplat <30cmH2O). End-Expiratory Lung Volume and strain will be measured every 6 hours from the inclusion to the extubation. | Other: Inflammatory markers<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| measure of the number of hours spent with a PaO2/FiO2 ratio under 200mmHg | measure of the number of hours spent with a PaO2/FiO2 ratio under 200mmHg : day 0,1,2,4,6,13 | until the 13th day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality at D28 | Verify if the patient is death at the 28th day | at the 28th day | 
| Ventilatory free days at D28 | To determine if the patient is free ventilatory at the 28th day | at the 28th day |