Clinical trial NCT05781802: V/Q Matching in Pressure Support Ventilation
Official title: Assessment of V/Q Matching During Pressure Support Ventilation With Electrical Impedance Tomography
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Acute Respiratory Failure
ARDS
Electrical Impedance Tomography
Keywords: Electrical impedance tomography
ARDS
V/Q matching
Lead sponsor: Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone Palermo
Sponsor class: OTHER
First posted: 2023-03-23
Enrollment: 15
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Adult patients who were admitted to ICU with acute respiratory distress syndrome (ARDS) or developing it during ICU stay.

Brief summary: The aim of this study is to describe the effects of different levels of pressure support on ventilation-perfusion matching in patients recovering from ARDS, using electrical impedance tomography.

Detailed description: Spontaneous breathing during mechanical ventilation has been attributed to both protective and negative effects on patient outcomes, largely varying based on the severity of lung injury. Indeed, in severe ARDS the avoidance of spontaneous efforts has an established protective role. However, spontaneous breathing promotes the distribution of tidal volume towards the dependent lung, and low levels of support pressure determine more homogeneous ventilation in patients recovering from ARDS, compared to higher support levels. Physiology supports the potential of spontaneous breathing to increase lung perfusion, through the decrease of intra-thoracic pressure leading to an increased venous return. This mechanism, in absence of right ventricular dysfunction, may lead to increased global lung perfusion. Furthermore, gas exchange improvements in experimental lung injury models during pressure support vs. controlled ventilation have been explained with redistribution of lung perfusion to nondependent lung areas and improvement of V/Q matching even in absence of significant lung recruitment.

Electrical impedance tomography has been clinically used as a non-invasive tool to assess V/Q matching in patients with ARDS and to compare V/Q matching prior to and after a cycle of prone position in spontaneously breathing patients with COVID-19.

The aim of this study is to describe the effects of different levels of pressure support on ventilation-perfusion matching in patients recovering from ARDS, using electrical impedance tomography.

Eligibility criteria: Inclusion Criteria:

* Age ≥ 18 years
* Need for invasive mechanical ventilation and ICU admission
* Diagnosis of ARDS at ICU admission or during ICU stay
* Informed consent
* Presence of central line in the internal jugular vein

Exclusion Criteria:

* Any contraindication to Electrical impedance tomography monitoring (e. g. severe chest trauma or wounds)
* Cardiogenic pulmonary edema
* Pulmonary embolism
* Chronic obstructive pulmonary disease
* Pulmonary fibrosis
* Asthma exacerbation
* Pneumothorax and/or chest drainages
* Pre-existing diaphragmatic function impairment
* Neuro-muscular disease or impairment
* Moribund patients with limitation of care or expected survival \<48h according to the treating physician

Primary outcomes:
measure: Changes in ventilation-perfusion matching
timeFrame: Measured after at least 20 minutes from the application of each of the levels of pressure support and at clinical stability
Secondary outcomes:
measure: Changes in gas exchange
timeFrame: Measured after at least 20 minutes from the application of each of the levels of pressure support and at clinical stability
measure: Changes in regional ventilation distribution
timeFrame: Measured after at least 20 minutes from the application of each of the levels of pressure support and at clinical stability
measure: Changes in regional perfusion distribution
timeFrame: Measured after at least 20 minutes from the application of each of the levels of pressure support and at clinical stability
Other outcomes:
Locations:
city: Palermo
country: Italy
facility: Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone. Università degli Studi di Palermo
Study officials:
References:
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