- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03462849
Expiratory Flow Limitation Assessment (FLAIR)
August 13, 2019 updated by: Hospices Civils de Lyon
Expiratory Fow Assessment in ARDS Patients
This study intended to assess the expiratory flow limitation (EFL) during tidal breath in patients intubated in intensive care unit (ICU) for moderate or severe acute respiratory distress syndrome (ARDS).
EFL is defined as the lack of increase in expiratory flow in response to an increase in alveolar-to-atmospheric pressure gradient.
It reflects airway closure.
Early studies have been done using the Negative expiratory pressure (NEP) technique, which is no longer available.
We proposed in present study a new method, which consists of diverting manually the expiratory flow to the atmosphere by-passing the expiratory valve.
We aimed at assessing EFL at positive expiratory pressure (PEP) 5 cmH2O in semi-recumbent then in supine position together with measurement of trans-pulmonary pressure and regional lung ventilation.
Higher PEP levels will be tested, namely 10, 15 and a trans-pulmonary PEP of 3 cmH2O, in semi-recumbent position.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
25
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
-
Grenoble, France
- CHU Grenoble Alpes
-
Lyon, France, 69004
- Hopital de la Croix Rousse
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- 18 years or more in age
- moderate to severe ARDS according to the Berlin definition : Intubated (or tracheotomized) and mechanically ventilated in the ICU
- no pregnancy
- informed consent from the next of kin
Exclusion Criteria:
- Contra-indication to PEP > 5 cmH2O
- extracorporeal membrane oxygenation (ECMO)
- chest tube
- mean arterial pressure < 65 mmHg
- Contra-indication to oesophageal device
- underlying disease fatal in less than one year
- active therapy limitation
- under guardian
- refusal to participate
- not affiliated to insurance regimen
- speaking barrier of the next of kin
- investigator not available
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Patients with EFL at PEP 5
Patients with EFL at PEP 5 at the time of inclusion either in supine or semi-recumbent position
|
increase in positive end expiratory pressure from 5 to 10 then 15 cmH2O then at the value for trans pulmonary end expiratory pressure amounting to 3 cmH2O
|
Other: Patients with no EFL at PEP 5
Patients with no EFL at PEP 5 at the time of inclusion in both supine and semi-recumbent positions
|
increase in positive end expiratory pressure from 5 to 10 then 15 cmH2O then at the value for trans pulmonary end expiratory pressure amounting to 3 cmH2O
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
EFL at PEP 5 cmH2O
Time Frame: at inclusion
|
A Fleish 2 pneumotachograph and a port to measure airway pressure are attached at the Y piece of the ventilator circuit and connected to a Biopac 150.
At the end of inspiration the air is expelled to the atmosphere upstream the expiratory valve.
The flow volume loop at baseline and that during the manoeuver are plotted and patients classified as EFL or not EFL (NFL).
Measurements are taken in semi-recumbent then after 5 minutes in supine position.
|
at inclusion
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Trans-pulmonary pressure at end expiratory at PEP 5
Time Frame: at inclusion
|
After insertion of esophageal balloon together with pneumotachograph and port for airway pressure trans-pulmonary pressure (airway-esophageal pressure) is measured after a 3-sec end-expiratory pause in semi-recumbent and then after 5 minutes in supine position
|
at inclusion
|
Trans-pulmonary pressure at end expiratory at PEP 10 in EFL and NFL patients
Time Frame: 15 minutes after PEP set to 10 cm H2O
|
PEP is increased to 10 cmH2O and 15 minutes later trans-pulmonary pressure is measured after a 3-sec end-expiratory pause in semi-recumbent position
|
15 minutes after PEP set to 10 cm H2O
|
Lung compliance at PEP 10 in EFL and NFL patients
Time Frame: 15 minutes after PEP set to 10 cm H2O
|
PEP is increased to 10 cmH2O and 15 minutes later lung compliance is measured after a 3-sec end-expiratory pause in semi-recumbent position
|
15 minutes after PEP set to 10 cm H2O
|
lung ventilation distribution at PEP 10 in EFL and NFL patients
Time Frame: 15 minutes after PEP set to 10 cm H2O
|
PEP is increased to 10 cmH2O and 15 minutes later lung ventilation is measured by using electrical impedance tomography (EIT) in semi-recumbent position (an EIT belt having been inserted together with the previous measurement devices).
|
15 minutes after PEP set to 10 cm H2O
|
Transcutaneous oxygen saturation (SpO2) at PEP 10 in EFL and NFL patients
Time Frame: 15 minutes after PEP set to 10 cm H2O
|
PEP is increased to 15cmH2O and 15 minutes later SpO2 is read from the vital functions monitoring device and SpO2/FIO2 computed
|
15 minutes after PEP set to 10 cm H2O
|
Trans-pulmonary pressure at end expiratory at PEP 15 in EFL and NFL patients
Time Frame: 15 minutes after PEP set to 15 cm H2O
|
PEP is increased to 15 cmH2O and 15 minutes later trans-pulmonary pressure is measured after a 3-sec end-expiratory pause in semi-recumbent position
|
15 minutes after PEP set to 15 cm H2O
|
Lung compliance at PEP 15 in EFL and NFL patients
Time Frame: 15 minutes after PEP set to 15 cm H2O
|
PEP is increased to 15 cmH2O and 15 minutes later lung compliance is measured after a 3-sec end-expiratory pause in semi-recumbent position
|
15 minutes after PEP set to 15 cm H2O
|
lung ventilation distribution at PEP 15 in EFL and NFL patients
Time Frame: 15 minutes after PEP set to 15 cm H2O
|
PEP is increased to 15 cmH2O and 15 minutes later lung ventilation is measured by using electrical impedance tomography (EIT) in semi-recumbent position (an EIT belt having been inserted together with the previous measurement devices).
|
15 minutes after PEP set to 15 cm H2O
|
transcutaneous oxygen saturation (SpO2) at PEP 15 in EFL and NFL patients
Time Frame: 15 minutes after PEP set to 15 cm H2O
|
PEP is increased to 15 cmH2O and 15 minutes later SpO2 is read from the vital functions monitoring device and SpO2/FIO2 computed.
|
15 minutes after PEP set to 15 cm H2O
|
Trans-pulmonary pressure at end expiratory at PEP to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O in EFL and NFL patients
Time Frame: 15 minutes after PEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O
|
PEP is set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O and 15 minutes later trans-pulmonary pressure is measured after a 3-sec end-expiratory pause in semi-recumbent position
|
15 minutes after PEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O
|
Lung compliance at PEP to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O in EFL and NFL patients
Time Frame: 15 minutes after PEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O
|
PEP is set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O and 15 minutes later lung compliance is measured after a 3-sec end-expiratory pause in semi-recumbent position
|
15 minutes after PEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O
|
lung ventilation distribution at PEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O in EFL and NFL patients
Time Frame: 15 minutes after PEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O
|
PEP is set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O and 15 minutes later lung ventilation is measured by using electrical impedance tomography (EIT) in semi-recumbent position (an EIT belt having been inserted together with the previous measurement devices).
|
15 minutes after PEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O
|
Transcutaneous oxygen saturation (SpO2) at PEEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O in EFL and NFL patients
Time Frame: 15 minutes after PEEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O
|
PEEP is increased to 15 cmH2O and 15 minutes later SpO2 is read from the vital functions monitoring device and SpO2/FIO2 computed.
|
15 minutes after PEEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O
|
lung recruitment at PEEP 10 in EFL and NFL patients
Time Frame: 15 minutes after PEEP set to 10 cm H2O
|
PEEP is increased to 10 cmH2O and 15 minutes later lung recruitment is measured between PEEP 10 and PEEP 5 (in each body position) from volume-pressure curves recorded at PEEP 10 and PEEP 5.
The lung recruitment is the change in lung volume for a given pressure (higher PEEP and 20 cmH2O)
|
15 minutes after PEEP set to 10 cm H2O
|
lung recruitment at PEEP 15 in EFL and NFL patients
Time Frame: 15 minutes after PEEP set to 15 cm H2O
|
PEEP is increased to 15 cmH2O and 15 minutes later lung recruitment is measured between PEEP 15 and PEEP 5 (in each body position) from volume-pressure curves recorded at PEEP 15 and PEEP 5.
The lung recruitment is the change in lung volume for a given pressure (higher PEEP and 20 cmH2O)
|
15 minutes after PEEP set to 15 cm H2O
|
lung recruitment at PEEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O in EFL and NFL patients in EFL and NFL patients
Time Frame: 15 minutes after PEEP set to 15 cm H2O
|
PEEP is increased to PEEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O and 15 minutes later lung recruitment is measured between PEEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O and PEEP 5 (in each body position) from volume-pressure curves recorded at PEEP set to reach Trans-pulmonary pressure at end expiratory =+3 cmH2O and PEEP 5.
The lung recruitment is the change in lung volume for a given pressure (higher PEEP and 20 cmH2O)
|
15 minutes after PEEP set to 15 cm H2O
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Claude Guerin, Pr, Hospices Civils de Lyon
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
February 5, 2018
Primary Completion (Actual)
May 2, 2019
Study Completion (Actual)
May 2, 2019
Study Registration Dates
First Submitted
March 6, 2018
First Submitted That Met QC Criteria
March 6, 2018
First Posted (Actual)
March 13, 2018
Study Record Updates
Last Update Posted (Actual)
August 14, 2019
Last Update Submitted That Met QC Criteria
August 13, 2019
Last Verified
August 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 69HCL17_0595
- 2017-A02557-46 (Other Identifier: ANSM)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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