- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04471090
Effects of Positional Therapy on Pulmonary Physiology in Patients Undergoing Mechanical Ventilation.
Study Overview
Status
Conditions
Detailed Description
In critically ill patients undergoing invasive mechanical ventilation (IMV), several negative effects converge, promoting the development of collapse in the dorsal areas of the lung. These among others include deep sedation, relaxation, prolonged immobility and the supine position. This results of an added impairment in lung function both in the mechanical and gas exchange. In addition lung collapse contributes to a significant increase in the heterogeneity the distribution of alveolar ventilation and perfusion that may increase the risk of ventilator-induced lung injury (VILI).
Postural therapy is widely recommended as prevention/treatment of pressure ulcers, whose presence, according to the Spanish Society of Intensive Care Medicine (SEMICYUC), is a quality criterion for intensive care units (ICUs), with a prevalence of 18% in these units compared to 7.8% in adult hospitalization. However, how postural changes may affect lung function is an aspect that has been scarcely studied. Given the strong influence of gravity on lung function, positional changes can produce significant alterations in the distribution of trans-pulmonary pressures (a decrease along the vertical gravitational axis of approximately 0.25 cmH2O per cm). Depending on the severity, distribution and location of the respiratory pathology, positional changes may have a significant effect either benefiting or impairing the patient's condition.
The investigators will dynamically assess the effects of routine lateral positioning up to 30-40º by means of electrical impedance tomography (EIT), a non-invasive, radiation-free functional bedside imaging technique that allows to monitor the regional distribution of ventilation and perfusion.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Fernando Suarez Sipmann, MD PhD
- Phone Number: +34 665052460
- Email: fsuarezsipmann@gmail.com
Study Locations
-
-
-
Madrid, Spain, 28006
- Recruiting
- Hospital Universitario de La Princesa
-
Contact:
- Fernando Suarez Sipmann, MD PhD
- Phone Number: +34 665052460
- Email: fsuarezsipmann@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients undergoing IMV under sedation, in a controlled ventilatory modality in passive conditions (i.e. without any spontaneous inspiratory efforts by the patient).
- Signature of the informed consent by family member or legal representative.
Exclusion Criteria:
- Presence of any clinical contraindication for postural therapy, including patient haemodynamic instability, traumatism, pathology or any other cause.
- Contraindication for the placement of the EIT electrode belt due to unstable spinal cord injury or other skin injuries or wounds in the thoracic region (surgical, traumatic, etc.)
- Assisted ventilatory modes in a non-passive breathing patient.
- Hypernatremia
- Patients with pacemakers or implantable automatic defibrillators (IAD).
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Regional ventilation and perfusion distribution ratio
Time Frame: 60 minutes
|
Percentage of relative ventilation in each Region Of Interest (ROI) in each of the studied positions
|
60 minutes
|
Global mechanical compliance and regional impedance compliance
Time Frame: 60 minutes
|
Global mechanical compliance and regional impedance compliance (CZ) for each ROI in each of the studied positions.
|
60 minutes
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assessment of lung mechanics.
Time Frame: 60 minutes
|
Changes in the lung mechanics during postural changes in their usual positions: supine position (SD), right lateral position (RLP) at 30º and left lateral position (LLP) at 30º.
Global compliance and regional compliance (impedance arbitrary units/cmH2O)
|
60 minutes
|
Assessment of ventilation/perfusion lung distribution.
Time Frame: 60 minutes
|
Changes in the regional distribution of lung ventilation and perfusion during postural changes in their usual positions: supine position (SD), right lateral position (RLP) at 30º and left lateral position (LLP) at 30º.
Percentage of relative ventilation and perfusion distribution in each region of interest (ROI).
Relative distribution (%) and derived indexes.
|
60 minutes
|
Assesment of changes in ventilation/perfusion in prone position.
Time Frame: 60 minutes
|
Changes in ventilation and perfusion in prone position if during the study this circumstance arises due to medical indication.
Percentage of relative ventilation and perfusion distribution in each region of interest (ROI).
Relative distribution (%) and derived indexes.
|
60 minutes
|
Assessment of the effects of postural therapy in cases of predominantly unilateral lung pathology
Time Frame: 60 minutes
|
Effects of postural therapy in cases of predominantly unilateral lung pathology.
Percentage of relative ventilation and perfusion distribution in each region of interest (ROI).
Relative distribution (%) and derived indexes.
|
60 minutes
|
Collaborators and Investigators
Investigators
- Principal Investigator: Fernando Suarez Sipmann, MD PhD, Fundación de Investigación Biomédica - Hospital Universitario de La Princesa
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PT-IMV
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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