- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04184674
Impact of the Transpulmonary Pressure on Right Ventricle Function in Acute Respiratory Distress Syndrome (VD-SDRA)
Pulmonary distension induced by mechanical ventilation physiologically alters right ventricle pre and after-load, hence might lead to right ventricle failure. The hypothesis is that in Acute Respiratory Distress Syndrome, the occurence of a right ventricle failure under lung protective ventilation might :
i) be correlated to the transpulmonary pressure level, ii) lead to global heart failure, iii) and extremely result in poor outcome and death.
The primary objective is to test the impact of transpulmonary pressure on right ventricular function in Acute Respiratory Distress Syndrome in adults and children.
Secondary objectives are :
i) to compare thresholds of transpulmonary pressure associated with right ventricle failure between children and adults.
ii) to assess if there is an association between transpulmonary pressure and morbidity and mortality.
- For pediatric patients, a specific monitoring with electrical impedance tomography (EIT) will allow:
- To assess if the transpulmonary pressure is associated with the level of regional pulmonary overdistention (or collapse) on electrical impedance tomography.(EIT)
- To assess if there is an association between the occurrence of right ventricular failure, and distribution of ventilation on EIT.
Study Overview
Status
Conditions
Detailed Description
Acute Respiratory Distress Syndrome (ARDS) is an acute inflammatory lung injury associated with a high pulmonary vascular permeability, leading to acute respiratory failure. Positive pressure mechanical ventilation,improves survival but might lead to ventilator-induced lung injury (VILI) and right ventricular failure. This hemodynamic effect is more important when compliance is decreased, especially in ARDS.
The use of long protective ventilation (with low tidal volumes and low plateau pressures) has improved prognosis of ARDS in adult patients. However, tidal volume and plateau pressures do not always reflect the lung deformation and the stress induced by the ventilation; these variables depend on the characteristics of the patient's respiratory system. Therefore, management focuses on ventilation strategies according to these characteristics.
Among tools used to evaluate respiratory physiological parameters, the esophageal pressure measurement is easily feasible at the bedside, and well estimates pleural pressure and pulmonary distension. During invasive ventilation, transpulmonary pressure (PL) can be obtained with the difference between the airway pressure and the esophageal pressure. Calculation of transpulmonary pressure in ARDS allows optimal ventilator management of adult and children treated for ARDS.
Although individualized ventilation techniques have shown some benefits in ARDS, studies have failed to show that survival could be improved by such strategies. This lack of efficacy could be partly explained by the hemodynamic impact of ventilation-induced pulmonary distension. It therefore seems essential to combine a robust assessment of right ventricular function with measurements of transpulmonary pressure in order to know the real hemodynamic impact of positive pressure ventilation in ARDS in adults and children.
The primary objective is to test the impact of transpulmonary pressure on right ventricular functionin ARDS adults and children.
Secondary objectives are :
i) to compare thresholds of transpulmonary pressure associated to right ventricle failure between children and adults ii) to assess if there is an association between transpulmonary pressure and morbidity and mortality.
- For pediatric patients, a specific monitoring with electrical impedance tomography (EIT) will allow:
- To assess if the transpulmonary pressure is associated with the level of regional pulmonary overdistention (or collapse) on electrical impedance tomography.(EIT)
- To assess if there is an association between the occurrence of right ventricular failure, and distribution of ventilation on EIT.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Meryl Vedrenne-Cloquet, MD
- Phone Number: +33 1 71 39 68 43
- Email: meryl.vedrenne@aphp.fr
Study Locations
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Boulogne-Billancourt, France, 92100
- Hopital Ambroise Pare
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Paris, France, 75015
- Hôpital Necker-Enfants Malades
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients over one month
- Patients with mild to severe ARDS (onset within 48 hours). ARDS definition will follow Berlin guidelines for adults, and Pediatric Acute Lung Injury Consensus Conference (PALICC) guidelines for children
- Signed consent
Exclusion Criteria :
- Neonates less than 28 days-old
- Pregnancy or breastfeeding
- Any contra-indication to esophageal manometry (less than one month esophagus surgery, bronchopleural or esotracheal fistula, latex allergy)
- No social care
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Acute Respiratory Distress Syndrome
Children of more than one month of age and adults hospitalized in Intensive Care Unit for Acute Respiratory Distress Syndrome.
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Measurements will be performed during the first three days of Acute Respiratory Distress Syndrome management :
Measurements will be performed during the first three days of Acute Respiratory Distress Syndrome management
The right ventricle systolic function will be assessed thanks to a transthoracic cardiac ultrasound in children, and a transthoracic of a transesophageal cardiac ultrasound in adults : Measurements will be performed during the first three days of Acute Respiratory Distress Syndrome management :
For pediatric patients: measurements will be performed during the first three days of Acute Respiratory Distress Syndrome management.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Right ventricle failure
Time Frame: Three days
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Right ventricle failure is defined, by ultrasound, as a composite criteria associating :
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Three days
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Airways pressure
Time Frame: Three days
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Airways pressure (Paw) will be measured in cmH2O thanks to a pneumotachograph connected to the ventilator.
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Three days
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Oesophageal pressure
Time Frame: Three days
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Esophageal pressure (Pes) will be measured in cmH2O thanks to an oesophageal balloon catheter introduced in the mid-esophagus of the patient and connected to a manometer.
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Three days
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Transpulmonary pressure calculation
Time Frame: Three days
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Measurements will be performed at different moments during the respiratory cycle: after an inspiratory pause to evaluate the tele-inspiratory transpulmonary pressure (PL-insp), and after an expiratory pause to evaluate the tele-expiratory transpulmonary pressure (PL-PEP ).
The PL-insp will be calculated using the ratio between the elastance of the chest wall (Ecw) and of the respiratory system (Ers) thanks to this formula PL = Paw - Paw x (Ecw/Ers).
The PL-exp will be calculated using the ratio between Paw et Pes (PL = Paw - Pes).
Transpulmonary pressure will be expressed in cmH2O.
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Three days
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Vaso-Active Inotrope Score (VIS)
Time Frame: Three days
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Correlation between transpulmonary pressure and morbidity.
Vaso-Active Inotrope Score is a hemodynamic score taking into account the cumulative doses of inotropic or vassopressive drugs.
It is obtained thanks this calculation : VIS = dopamine dose (µg/kg/min) + dobutamine dose (µg/kg/min) + 100 x epinephrine dose (µg/kg/min) + 10 x milrinone dose (µg/kg/min) + 10000 x vasopressin dose (µg/kg/min) + 100 x norepinephrine dose (µg/kg/min).
Its value ranges from zero, which is associated to a better outcome, to the maximum cumulative dose without any limit.
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Three days
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Duration of treatment with vasoactive or inotropic drugs
Time Frame: 3 months after hospitalization in Intensive Care Unit
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Number of days under vaso-active or inotropic drugs
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3 months after hospitalization in Intensive Care Unit
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Pediatric logistic organ dysfunction score
Time Frame: Three days
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Pediatric logistic organ dysfunction score is a specific pediatric multiple organ dysfunction score that includes 10 variables corresponding to 5 organ dysfunctions.
Values extend from 0 (best outcome) to 33 (worst outcome).
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Three days
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Sepsis-related Organ Function Assessement score
Time Frame: Three days
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Sepsis-related Organ Function Assessement score is a multiple organ dysfunction score that includes several variables corresponding to 6 organ dysfunctions.
Values extend from 0 (best outcome) to 24 (worst outcome).
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Three days
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Invasive and non invasive ventilation free days
Time Frame: 3 months after hospitalization in Intensive Care Unit
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Number of invasive and non invasive ventilation free days
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3 months after hospitalization in Intensive Care Unit
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Lung and Chest Wall compliance
Time Frame: Three days
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Lung and chest wall compliances (in mL/cmH2O) will be calculated thanks to the respective ratios tidal volume/(PL-insp - PL-PEP) and tidal volume/(Pes insp - Pes-PEP).
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Three days
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Length of hospitalization
Time Frame: 3 months after hospitalization in Intensive Care Unit
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Length of hospitalization in Intensive Care Unit and in hospital in days.
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3 months after hospitalization in Intensive Care Unit
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Mortality at 28 days
Time Frame: 28 days
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Death in Intensive Care Unit and at 28 days of hospitalization.
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28 days
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Mortality in Intensive Care Unit
Time Frame: 3 months after hospitalization in Intensive Care Unit
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Death in Intensive Care Unit.
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3 months after hospitalization in Intensive Care Unit
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Eletrical impedance tomography
Time Frame: 3 days
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Electrical impedance tomography will be monitored only in children.
Several methods will be used and compared, based on e.g.
pixel information of lung aeration, to assess end-expiratory lung volume (ELLV, in mL) and the distribution of ventilation
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3 days
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Collaborators and Investigators
Investigators
- Principal Investigator: Meryl Vedrenne-Cloquet, MD, Assistance Publique - Hôpitaux de Paris
- Study Director: Brigitte Fauroux, MD, PhD, Assistance Publique - Hôpitaux de Paris
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- APHP191033
- 2019-A02814-53 (Other Identifier: IDRCB number)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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