Clinical trial NCT03367442: Driving Pressure in Trauma
Official title: Driving Pressure in Trauma. Morbi-mortality and Pulmonary Mechanics in Relation to Transpulmonary Driving Pressures in Patients With Chest Trauma. A Prospective Observational Study
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Sever Chest Trauma
Mechanical Ventilation
Keywords: Thoracic trauma
mechanical ventilation
Acute respiratory distress syndrome
Esophageal pressure
Pleural pressure
Lead sponsor: University Hospital, Montpellier
Sponsor class: OTHER
First posted: 2017-12-08
Enrollment: 50
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Patients with sever chest trauma under mechanical ventilation

Brief summary: Traumatic chest injuries are responsible for significant morbidity and the cause of trauma-related death in 20%-25% of cases. Thoracic trauma can include multiple injuries, mainly osseous (ribs, sternal fractures, flail chest), pulmonary contusions or lacerations, pneumothoraces and pleural effusions, and sometimes involve wounds to the heart and vessels (aortic dissection, cardiac contusion) or diaphragm. Following trauma, patients with thoracic injuries are at risk of developing acute respiratory distress syndrome (ARDS). This worsening of respiratory function can lead to requirement for mechanical ventilation. In addition, changes to gas exchange may also be generated or aggravated by mechanical ventilation as a result of barotrauma, biotrauma, or ventilation-associated pneumonia. Many mechanical ventilation strategies have been tried in trauma patients in the last 30 years to determine the optimal method of maximizing gas exchange with minimal lung damage. The driving pressure of the respiratory system has been shown to strongly correlate with mortality in a recent large retrospective ARDSnet study. Respiratory system driving pressure \[plateau pressure-positive end-expiratory pressure (PEEP)\] does not account for variable chest wall compliance especially in cases of chest trauma. Esophageal manometry can be utilized to determine transpulmonary driving pressure. A recent study suggests that utilizing PEEP titration to target positive transpulmonary pressure via esophageal manometry causes both improved elastance and driving pressures. Treatment strategies leading to decreased respiratory system and transpulmonary driving pressure at 24 h may be associated with improved 28 day mortality. However, currently no specific study with chest trauma patients exists. We propose to investigate the effect of hight transpulmonary driving pressure on duration on mechanical ventilation, length of stay and mortality in patients with sever chest trauma.


Eligibility criteria: Inclusion Criteria:

* Major patients (18-90 years old)
* Affiliated to the social security
* Hospitalized following severe trauma chest trauma
* Mechanical ventilatory support for a minimum of 72 hours

Exclusion criteria:

* Minor patients,
* Patients under tutorship / curatorship,
* Pregnant or lactating women

Primary outcomes:
measure: Duration of mechanical Ventilation
timeFrame: 1 day
Secondary outcomes:
measure: During of SDRA
timeFrame: 1 day
measure: Length of stay in intensive care unit
timeFrame: 1 day
measure: Mortality
timeFrame: 1 day
measure: Pulmonary compliance
timeFrame: 1 day
measure: Pulmonary stress and strain
timeFrame: 1 day
Other outcomes:
Locations:
city: Montpellier
country: France
facility: Uhmontpellier
Study officials:
affiliation: University Hospital, Montpellier
name: Jonathan CHARBIT, MD
role: PRINCIPAL_INVESTIGATOR
References: