CompletedNot Applicable

Assessing Lung Inhomogeneity During Ventilation for Acute Hypoxemic Respiratory Failure

Canada20 participantsStarted 2019-03-01

Plain-language summary

Mechanical ventilation can cause damage by overstretching the lungs, especially when the lungs are collapsed or edematous. Raising ventilator pressures can reduce lung collapse and this can prevent overstretching from mechanical ventilation. It remains uncertain how much pressure (PEEP - positive end-expiratory pressure) should be used on the ventilator and how to identify patients who will benefit from higher ventilator pressures vs. lower ventilator pressures. The investigators are using a unique new imaging technology, electrical impedance tomography (EIT), to study this problem and to determine the safest and most effective ventilator pressure level. The results of this study will inform future trials of higher vs. lower PEEP strategies in mechanically ventilated patients.

Who can participate

Age range18 Years

SexALL

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AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.

Inclusion Criteria: * Acute (≤7 days) hypoxemia with PaO2:FiO2 ratio less than or equal to 200 mm Hg * Oral endotracheal intubation and mechanical ventilation * Bilateral airspace opacities on chest radiograph or CT Exclusion Criteria: * Contraindication to EIT electrode placement (burns, chest wall bandaging limiting electrode placement) * Contraindication to esophageal catheter placement (recent upper GI surgery, actively bleeding esophageal varices) * Respiratory failure predominantly due to cardiogenic cause or fluid overload * Ongoing hemodynamic instability (requiring 2 vasopressor agents by continuous infusion AND rising vasopressor infusion rate requirements in the previous 8 hours) * Ongoing ventilatory instability (P/F \< 70 mm Hg, pH \< 7.2; ventilator driving pressures, PEEP, or FiO2 increasing by more than 25% in previous 30 minutes) * Intracranial hypertension (suspected or diagnosed by medical team) * Known or suspected pneumothorax recognized within previous 72 hours * Bronchopleural fistula * Bridge to lung transplant * Recent lung transplantation (within previous 6 weeks) * Attending physician deems the transient application of high airway pressures (\>40 cm H2O) to be unsafe

What they're measuring

Intratidal ventilation heterogeneity

Timeframe: Assessed after completion of 3 hours on randomized strategy (EIT vs ExPRESS)

Trial details

NCT IDNCT03589482

SponsorUniversity Health Network, Toronto

Sponsor typeOTHER

Study typeINTERVENTIONAL

Primary completion2021-03-31