Hemodynamic Effects of Two Modalities of Alveolar Recruitment Maneuvers - ICU Patients (CHARM-ICU)
Cardiac Output, Hemodynamic Optimization, Monitoring Blood Pressure
About this trial
This is an interventional diagnostic trial for Cardiac Output
Eligibility Criteria
Inclusion Criteria:
- Patient over 18 years old
- Patient under general anesthesia
- Intubated patient under controlled invasive mechanical ventilation
- Patient with invasive hemodynamic monitoring allowing monitoring of cardiac output and stroke volume
- Patient sufficiently sedated (BIS between 40 and 60) and/or curarized (TOF < 2/4 at the orbicularis) to avoid inspiratory effort
- Patient optimized on the hemodynamic level, in particular with regard to blood volume, following the data from hemodynamic monitoring and the recommendations of the French Society of Anesthesia and Resuscitation (RFE SFAR 2013 - Perioperative Vascular Filling Strategy)
- Patient covered by a Social Security plan
- Consent of close relatives or trusted person (if present)
- Patient admitted in polyvalent resuscitation within the Peri-Operative Medicine Unit of Clermont-Ferrand hospital suffering from respiratory distress syndrome for less than 24 hours
Exclusion Criteria:
- Contraindication to the use of cardiac output measurement by transpulmonary thermodilution
- Cardiac arrhythmia
- Severe valvulopathy
- Contraindication to the use of the Analysis of pulmonary aeration will be performed using the non-invasive technique of electrical impedance tomography with the placement of an electrode belt on the patient's chest. Values will be recorded with this belt :
technique
- Left ventricular ejection fraction (LVEF) < 45% and/or right ventricular failure
- History of pulmonary lobectomy and/or pneumectomy and/or known emphysema
- Patient with restrictive or obstructive lung disease
- Body mass index (BMI) < 16.5 or > 30 kg.m-2
- Pregnancy
- Major under legal protection (guardianship, curators, safeguard of justice)
Sites / Locations
- CHURecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Continuous positive airway pressure (CPAP) then extended sigh
extended sigh then continuous positive airway pressure (CPAP)
Patients assigned to this group will receive a CPAP ARM (40cmH2O during 50 seconds), followed by a 10-minute pause corresponding to a period of return to basal state. Then an ARM by extended sigh (e-sigh) also 50 seconds (driving pressure at 10cmH2O and successive PEEP levels at 10, 15, 20, 25 and 30cmH2O, with respiratory frequency fixed at 30/min in controlled pressure). Hemodynamic (blood pressure, cardiac output, stroke volume) and ventilatory measurements will be performed the last 10 seconds of each recruitment maneuver.
Patients assigned to this group will receive an ARM by extended sigh (e-sigh) during 50 seconds (driving pressure at 10cmH2O and successive PEEP levels at 10, 15, 20, 25 and 30cmH2O, with respiratory frequency fixed at 30/min in controlled pressure), followed by a 10-minute pause corresponding to a period of return to basal state. Then they receive a CPAP ARM (40cmH2O during 50 seconds). Hemodynamic (blood pressure, cardiac output, stroke volume) and ventilatory measurements will be performed the last 10 seconds of each recruitment maneuver.