End-expiratory Transpulmonary Pressure-guided vs Electrical Impedance Tomography-guided PEEP Titr… (NCT06697717) | Clinical Trial Compass
RecruitingNot Applicable
End-expiratory Transpulmonary Pressure-guided vs Electrical Impedance Tomography-guided PEEP Titration Methods in Patients With Intra-abdominal Hypertension Combined With Acute Respiratory Distress Syndrome: a Randomized Crossover Controlled Study
China20 participantsStarted 2025-01-01
Plain-language summary
This study aims to adopt a randomized crossover design to compare the effects of end-expiratory transpulmonary pressure-guided PEEP titration and EIT-guided PEEP titration on local lung ventilation, shunt, dead space, and ventilation-perfusion (V/Q) ratio as monitored by EIT. Additionally, it will evaluate their impact on respiratory mechanics, chest wall mechanics, mechanical power, hemodynamics, gas exchange, intra-abdominal pressure, abdominal perfusion pressure, and renal perfusion. By identifying an optimal PEEP titration strategy for patients with intra-abdominal hypertension (IAH) and acute respiratory distress syndrome (ARDS), this study aims to develop a mechanical ventilation approach that maintains lung recruitment and minimizes lung injury while avoiding adverse effects on other organs. The findings could facilitate the clinical application of this strategy and benefit a broader population of patients with IAH and ARDS.
Who can participate
Age range18 Years – 80 Years
SexALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion criteria
✓. age: 18-80 years;
✓. meets IAH ≥12 mmHg;
✓. meets the diagnostic criteria of the new global definition of ARDS in the 2023 edition;
✓. PaO2/FiO2 ≤ 150;
✓. within 36 hours of invasive mechanical ventilation;
✓. patients or their family members were consulted, agreed to participate in the trial, and signed an informed consent form.
Exclusion criteria
✕. Age \<18 years or age \>80 years;
✕. uncorrected shock of any type;
✕. chronic obstructive pulmonary disease, interstitial lung disease, pulmonary embolism, right heart failure, pulmonary hypertension, or severe cardiac arrhythmia;
✕. pneumothorax or bronchopleural fistula or lobectomy or other surgery of the lungs within 2 weeks of surgery;
What they're measuring
1
Difference between the optimal PEEP titrated based on end-expiratory transpulmonary pressure and that guided by EIT
✕. non-invasive ventilation or transnasal high-flow oxygen;
✕. with relevant contraindications to the application of EIT (large chest skin injuries, infections, pacemaker implanters, in vivo automatic defibrillator implantation, etc.) pneumothorax, mediastinal emphysema, massive pleural effusion;
✕. oesophageal obstruction, oesophageal perforation, severe oesophageal variceal bleeding, upper gastrointestinal surgery, and other factors that make it impossible to place an oesophageal pressure catheter;
✕. diaphragmatic hernia, thoracic deformity; patients with obvious pulmonary hernias;