Open Lung Strategy in Critically Ill Morbid Obese Patients
Obesity, Respiratory Insufficiency, Right-Sided Heart Failure
About this trial
This is an interventional treatment trial for Obesity
Eligibility Criteria
Inclusion Criteria:
- ICU admitted requiring intubation and mechanical ventilation
- BMI ≥ 35 kg/m2
- Waist circumference > 88 cm (for women)
- Waist circumference > 102 cm (for men)
Exclusion Criteria:
- Known presence of esophageal varices
- Recent esophageal trauma or surgery
- Severe thrombocytopenia (Platelets count ≤ 5,000/mm3)
- Severe coagulopathy (INR ≥ 4)
- Presence or history of pneumothorax
- Pregnancy
- Patients with poor oxygenation index (PaO2/FiO2< 100 mmHg with at least 10 cmH2O of PEEP)
- Pacemaker and/or internal cardiac defibrillator
- Hemodynamic parameters: systolic blood pressure (SBP) <100 mmHg and >180 mmHg, or if SBP is between 100-180 mmHg on high dose of IV continuous infusion norepinephrine (>20 μg per minute), or dobutamine (>10 μg per minute), or dopamine (>10 μg per Kg per minute), or epinephrine (>10 μg per minute).
Sites / Locations
- Massachusetts General Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
PEEP_Titration_INCREMENTAL
PEEP_Titration_DECREMENTAL
The investigators will compare 3 levels of PEEP (BASELINE versus PEEP INCREMENTAL versus PEEP DECREMENTAL). Baseline PEEP is based in the standard of care PEEP used in the participant units. PEEP incremental value is based in transpulmonary pressure. Intervention : PEEP INCREMENTAL
The investigators will compare 3 levels of PEEP (BASELINE versus PEEP INCREMENTAL versus PEEP DECREMENTAL). Baseline PEEP is based in the standard of care PEEP used in the participant units. PEEP decremental value is based in lung recruitment maneuver followed by a best compliance curve during PEEP decrements. Intervention :PEEP DECREMENTAL