Clinical trial NCT06386120: Respiratory Function Monitoring of Mechanical Ventilation in Patients With Chest Blunt Injury
Official title: Respiratory Function Monitoring of Patients With Chest Blunt Injury With Mechanical Ventilation
Study type: OBSERVATIONAL
Overall status: NOT_YET_RECRUITING
Conditions: Lung Contusion
Keywords: chest contusion
lung contusion
electrical impedance tomography
pulmonary perfusion
Lead sponsor: Peking University People's Hospital
Sponsor class: OTHER
First posted: 2024-04-26
Enrollment: 80
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The cohort will be selected from a tertiary hospital

Brief summary: The goal of this observational study is to learn about EIT in observing the application of lung protective ventilation strategies in patients with pulmonary contusion, particularly the impact on pulmonary ventilation blood flow ratio, oxygen, and condition. The main question it aims to answer is:

Can lung protective ventilation strategies improve respiratory function in patients with severe chest contusion? We will collect clinical data of participants who already taking lung protective ventilation strategies as part of their regular medical care.

Detailed description: Trauma is the leading cause of death among middle-aged and young people in China, with over 25% of patients dying from chest trauma. The incidence of pulmonary contusion in severe chest trauma is over 70%, and it is an important cause of respiratory failure and even death in patients. The occurrence of pulmonary contusion and respiratory failure in patients with chest contusion is a dynamic process, and Regional inhomogeneities of the damaged lung should be taken into consideration to develop improved ventilation strategies. Currently, there is no ideal monitoring method to evaluate the severity of injury, and guide the ventilation strategies. Electrical impedance tomography (EIT) is a non-invasive, radiation-free imaging technique. It measures regional lung ventilation and aeration distribution by means of changes in electrical potentials at the skin surface of the chest wall during breathing cycles, which has been proven to have good practicality in patients with non-invasive ARDS and pulmonary embolism. In this study, we aim to characterize the physiologic effects of positive end expiratory pressure (PEEP) on key mechanisms of regional lung protection, namely: recruitment, reduced atelectrauma, and improved ventilation-perfusion matching, by CT scan and EIT

Eligibility criteria: Inclusion Criteria:

* Patients with severe chest contusion admitted to the intensive care unit (ICU);
* Abbreviated Injury Scale (AIS) ≥ 3 and/or Blunt Pulmonary Contusion 18 score (BPC18) ≥ 3;
* Age range from 18 to 90 years old;
* Mechanical ventilation;
* Stay in the ICU for less than 12 hours.

Exclusion Criteria:

* Perinatal women;
* Expected to be mechanically ventilated for less than 48 h;
* Expected duration of stay in the ICU is less than 24 hours;
* There are contraindications for the use of EIT (pacemaker implantation, local skin wounds after chest surgery, etc.);
* Accept extracorporeal membrane oxygenator;
* Mechanical ventilation\>7 days;
* Confirmed ventilator-associated pneumonia;
* Pneumothorax without drainage or presence of subcutaneous emphysema.

Primary outcomes:
measure: ventilation blood flow ratio
timeFrame: through study completion, an average of 1 year
Secondary outcomes:
measure: oxygenation index
timeFrame: through study completion, an average of 1 year
measure: 28-day mortality
timeFrame: through study completion, an average of 1 year
measure: Mechanical ventilation-free from day 1 to 28
timeFrame: through study completion, an average of 1 year
measure: Length of ICU stay
timeFrame: through study completion, an average of 1 year
measure: Length of hospital stay
timeFrame: through study completion, an average of 1 year
measure: The rate of successful weaning
timeFrame: through study completion, an average of 1 year
Other outcomes:
Locations:
Study officials:
affiliation: Peking University People's Hospital
name: Shu Li, doctor
role: PRINCIPAL_INVESTIGATOR
References: