Optimal PEEP Titration Combining Transpulmonary Pressure Measurement and Electric Impedance Tomography
ARDS, Human
About this trial
This is an interventional treatment trial for ARDS, Human
Eligibility Criteria
Inclusion Criteria:
- Orotracheally intubated patients ventilated in volume control mode with moderate and severe hypoxic respiratory failure according to the ARDS Berlin definition.
- 100 Hgmm ≤ PaO2/FiO2 ≤ 200 Hgmm, PEEP ≥ 5 cmH2O (moderate) or PaO2/FiO2 ≤ 100 Hgmm, PEEP ≥ 5 cmH2O (sever)
Exclusion Criteria:
- age under 18
- pregnancy
- pulmonectomy, lung resection in the past medical history
- clinically end stage COPD
- sever hemodynamic instability (vasopressor refractory shock)
- sever bullous emphysema and/or spontaneous pneumothorax in the past medical history
- chest drainage in situ due to pneumothorax and/or bronchopleural fistula
- contraindication of the application of oesophageal balloon catheter (oesophageal ulcer, oesophageal perforation, oesophageal diverticulosis, oesophageal cancer, oesophageal varices, recent operation on oesophagus and/or stomach, sever coagulopathy)
Sites / Locations
- University of Szeged, Department of Anesthesiology and Intensive TherapyRecruiting
Arms of the Study
Arm 1
Experimental
Recruitment manoeuvre
Volume control (VC) ventilation mode with a tidal volume of 6 mL/kg of ideal body weight P/V tool assessment Baseline measurements CT scan of chest without EIT belt Re-establishment of EIT belt, continuous EIT and transpulmonary pressure measurement during the recruitment and de-recruitment manoeuvre. increment phase: constant volume settings increasing PEEP with 4 cmH2O following each 10 consecutive controlled breath until reaching a peak pressure of 40 cmH2O decrement phase: constant volume settings decreasing PEEP with 4 cmH2O following each 10 consecutive controlled breath not lower than 2 cmH20 from target PEEP target PEEP level is defined where the end-expiratory transpulmonary pressure is 0-1 cmH2O P/V recruitment with target end-PEEP level Removal of EIT belt, CT scan of chest Continuous EIT and transpulmonary pressure measurement with the initial FiO2 and the new PEEP settings