Ventilator-induced Right Ventricular Injury During EIT-based PEEP Titration in Patients With ARDS (RIGHTENARDS)
Acute Respiratory Distress Syndrome, Right Ventricular Dysfunction
About this trial
This is an interventional diagnostic trial for Acute Respiratory Distress Syndrome focused on measuring Acute respiratory distress syndrome, Mechanical ventilation, Right ventricular dysfunction, Positive end-expiratory pressure, Electrical impedance tomography, Echocardiography
Eligibility Criteria
Inclusion criteria:
- Moderate to severe acute respiratory distress syndrome
- Inclusion within 72 hours of acute respiratory distress syndrome diagnosis
- Endotracheal intubation or tracheostomy
Exclusion criteria:
- Age lower than 18 years old
- Pregnancy
- Absence of informed consent
- Thoracic surgery or lung transplant during the admission
- Contraindications to recruitment maneuvers (mean arterial pressure lower than 65 mmHg despite administration of fluids or vasopressors, active air leaks through a chest tube, pneumothorax or subcutaneous or mediastinal emphysema in absence of chest drainage)
- Contraindications to electrical impedance tomography (contraindication to recruitment maneuvers, presence of pacemakers or other electronic devices in the chest, injuries or burns in the electrode placement area)
Sites / Locations
- University Hospital of PaduaRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Experimental
Experimental
Experimental
PEEP level according to the low PEEP-FiO2 table
PEEP minimizing the risk of overdistension and atelectasis
PEEP minimizing the risk of overdistension
PEEP minimizing the risk of atelectasis
Positive end-expiratory pressure (PEEP) level selected based on patient's fraction of inspired oxygen (FiO2) according to the low PEEP-FiO2 table proposed by the Acute Respiratory Distress Syndrome Network Guidelines
Positive end-expiratory pressure (PEEP) level selected based on the intersection between the curves of the cumulative percentages of compliance loss due to alveolar overdistension and atelectasis, respectively, as assessed with an electrical impedance tomography-based decremental PEEP trial
Highest positive end-expiratory pressure (PEEP) level associated with no alveolar overdistention selected based on the curve of the cumulative percentage of compliance loss due to alveolar overdistension, as assessed with an electrical impedance tomography-based decremental PEEP trial
Lowest positive end-expiratory pressure (PEEP) level associated with no alveolar collapse selected based on the curve of the cumulative percentage of compliance loss due to alveolar collapse, as assessed with an electrical impedance tomography-based decremental PEEP trial