Clinical trial NCT04818554: Epidemiology and Prognosis of ARDS After Pulmonary Resection Surgery
Official title: Epidemiology and Prognosis of ARDS After Pulmonary Resection Surgery
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Thoracic
Pulmonary Restrictive Disease
ARDS
Keywords: Thoracic surgery
ARDS
Pulmonary resection
Ventilation
Lead sponsor: University Hospital, Montpellier
Sponsor class: OTHER
First posted: 2021-03-26
Enrollment: 50
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patient with ARDS hospitalized in the DAR ADV intensive care unit after thoracic resection surgery

Brief summary: The improvement in ARDS mortality over the last 20 years seems to be largely explained by the reduction of mechanical ventilation-induced injury (VILI). VILI is essentially related to volotrauma closely associated with "strain" and "stress". The pulmonary stress corresponds to the transpulmonary pressure (alveolar pressure - pleural pressure), and the strain to the change in lung volume related to the functional residual capacity (FRC) of the injured lung at PEEP = 0. The volotrauma corresponds therefore to the generalized excess of stress and strain on the injured lung.

The initial therapeutic strategy consists in protective ventilation with a tidal volume of 6 ml/kg of theoretical ideal weight (predicted by height), associated with a high respiratory rate between 25 and 30 cycles per minute to control PaCO2 (\< 50 mmHg), apply a high positive expiratory pressure PEEP according to FiO2, maintain a plateau pressure (PP) lower than 30 cmH20, reduce instrumental dead space, use curarization, recruitment maneuvers such as alternate prone, improve ventilation-perfusion adequacy using inhaled NO.

As a last resort, extracorporeal oxygenation by veno-venous ECMO is a device to supplement respiratory function by improving oxygenation and ensuring decarboxylation. Veno-venous ECMO is indicated in severe ARDS with PaO2/FiO2 \< 80 mmHg and/or when mechanical ventilation becomes unsafe due to increased plateau pressure despite optimized ARDS management including high PEEP levels, curarization and prone position.

After lung resection surgery, the incidence of ARDS is 2-8% and its prognosis remains more poor, despite advances in management, with a mortality of up to 60%. Risk factors include intraoperative vascular filling, type of pulmonary resection, and predicted postoperative respiratory function. Early support with VV ECMO is vital in some patients to treat severe hypoxemia, due to variable surgical reduction of lung parenchyma depending on carcinological involvement or initial lung pathology. ). There are very few data concerning these patients with pulmonary resection. The primary objective of this study is to describe the prevalence of ARDS and the risk factors for its occurrence after pulmonary resection surgery. The secondary objective is to compare the ventilation parameters (especially motor pressure) in patients with reduced lung parenchyma in ARDS under VV ECMO with those who did not use VV ECMO assistance.


Eligibility criteria: Inclusion criteria:

- Patient hospitalized following ARDS after thoracic resection surgery

Exclusion criteria:

- Refusal to participate after receiving the information letter

Primary outcomes:
measure: Prevalence of ARDS
timeFrame: 1 day
measure: risk factors for its occurrence after pulmonary resection surgery
timeFrame: 1 day
Secondary outcomes:
measure: According to the usual clinico-biological data of monitoring in intensive care
timeFrame: 1 day
Other outcomes:
Locations:
city: Montpellier
country: France
facility: UH Montpellier
Study officials:
affiliation: UH MONTPELLIER
name: hélène David, PHD
role: STUDY_DIRECTOR
References: