Early PP Monitored by EIT in Patients With ARDS

Study Overview
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Brief Summary
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Acute Respiratory Distress Syndrome (ARDS) is a syndrome characterized by respiratory distress and refractory hypoxemia caused by pulmonary and extra-pulmonary factors. Despite improvements in diagnosis and treatment in recent years, the mortality rate of severe ARDS is still around 40%. The distribution of lung lesions in ARDS patients is significantly gravity-dependent. Even with lung-protective ventilation strategies, tidal volume is concentrated in the ventral lung region, leading to ventilator-associated lung injury. Prone position ventilation can increase ventilation to the dorsal lung tissue and improve the ventilation-perfusion ratio, thus improving oxygenation. During prone position ventilation in ARDS patients, lung-protective ventilation strategies should be maintained, but with different respiratory mechanics from the supine position, requiring adjustment of ventilator parameters. Electrical Impedance Tomography (EIT) technology can be used for bedside monitoring of mechanically ventilated patients, providing real-time feedback on the patient's ventilation status and having great potential for clinical applications. Investigators believes that EIT monitoring during prone position ventilation in ARDS patients can individualize lung-protective ventilation strategies, minimize alveolar overdistension and collapse, improve the weaning success rate of invasive ventilation, and ultimately improve patient prognosis.

Official Title
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Early Prone Positioning Monitored by Electrical Impedance Tomography in Patients With Acute Respiratory Distress Syndrome

Conditions
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Acute Respiratory Distress Syndrome

Intervention / Treatment
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* Procedure: EIT-guided mechanical ventilation strategy
* Procedure: Lung protective ventilation group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years old； Meets the diagnostic criteria for ARDS according to the 2012 Berlin definition； Intubation with invasive mechanical ventilation time < 36 hours； PaO2/FiO2 < 150mmHg. Exclusion Criteria: Contraindication to the prone position; Contraindication to the EIT; Patients have received extracorporeal membrane oxygenation treatment.

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EIT guided group<br>During prone ventilation, the PEEP level is adjusted based on EIT monitoring. | Procedure: EIT-guided mechanical ventilation strategy<br>* During prone ventilation, the PEEP level is adjusted based on EIT monitoring. The optimal PEEP is the lowest sum of collapse and overdistension percentages<br>|
| Other: Lung protective ventilation group<br>Lung-protective ventilation strategy during prone positioning that continues the supine position. | Procedure: Lung protective ventilation group<br>* Lung-protective ventilation strategy during prone positioning that continues the supine position.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 28-day weaning rate from invasive mechanical ventilation | After weaning from invasive mechanical ventilation lasting more than 48 hours, continuation with either high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV). | At 28 days of hospitalization. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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acute respiratory distress syndrome, prone position, electrical impedance tomography, mechanical ventilation