- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04475068
Postural Recruitment Maneuver in Patients With Acute Respiratory Distress Syndrome Due to COVID-19 Infection
August 23, 2021 updated by: Rollin Roldán, Hospital Nacional Edgardo Rebagliati Martins
Feasibility and Physiological Effects of a Postural Recruitment Maneuver in Patients With Acute Respiratory Distress Syndrome Due to COVID-19 Infection
The purpose of this study is to evaluate if a postural recruitment maneuver (PRM) improves the aeration and distribution of lung ventilation in patients with Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19 infection; without the need to reach high airway pressures as in the standard lung recruitment maneuver and / or place the patient in prone position.
This strategy could be particularly useful in the context of a major health emergency in centers with limited resources.
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
The PRM is based on the known effect of gravity on transpulmonary pressure (PL).
Two principles explain its mechanism of action: 1) the first indicates that atelectasis and poorly ventilated areas of the lung can improve their aeration by putting the lung in the highest position.
Opposite lateral decubitus causes that upper lung to have a higher PL and allow a recruiting effect at moderate airway pressures.
2) The second principle is based on Laplace's Law and postulates that once the upper lung is recruited, it remains without lung collapse if a sufficient level of positive end-expiratory pressure (PEEP) is applied.
Based on these two precepts, PRM consists of sequentially moving the patient from the supine to the left lateral decubitus to recover the aeration of the right lung.
After that, the patient is placed in the right lateral position to recruit the left lung; keeping the right lung without collapse by continuous use of PEEP.
Finally, the patient returns to the supine position looking for an improvement in the distribution of ventilation and global pulmonary aeration, with a subsequent improvement in gas exchange and pulmonary mechanics.
Study Type
Observational
Enrollment (Actual)
15
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
-
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Lima
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Jesús María, Lima, Peru, Lima 11
- Hospital Rebagliati
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-
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
16 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Sampling Method
Non-Probability Sample
Study Population
This physiological study will enroll 12 adult ARDS patients admitted to the COVID Intensive Care Unit of Rebagliati Hospital.
Informed consent will be obtained from the patient or legally authorized substitute decision maker.
Description
Inclusion Criteria:
- Patients > 18 years of age
- Patients with moderate-to-severe ARDS as per the Berlin definition
- Infection due to COVID-19
- Body mass index (BMI) ≤ 35 kg /m^2.
Exclusion Criteria:
Contraindication for EIT monitoring
- Unstable spine or pelvic fractures
- Pacemaker, automatic implantable cardioverter defibrillator
- Skin lesions between the 4th and 5th ribs where the EIT belt is worn
- Pregnancy
Major hemodynamic instability::
- Mean arterial pressure lower than 60 mm Hg despite adequate fluid resuscitation and use of vasopressors.
- FC> 120 or <60 per minute
- Presence of uncontrolled arrhythmias.
- More than 1 week of mechanical ventilation
- Failure of more than 2 extrapulmonary organs.
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
- Observational Models: Cohort
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Moderate to severe ARDS patients due to COVID-19 infection
Mechanically ventilated patients with moderate to severe ARDS due to COVID-19 infection admitted to the COVID Intensive Care Unit of Rebagliati Hospital.
|
Prior to initiating the protocol, patients will be sedated deeply with sedatives and opioids and paralyzed.
Patients will be evaluated in 5 positions sequentially: 1) Supine 2) Left lateral 3) Supine 4) Right lateral 5) Supine.
The side with the least ventilation evaluated by EIT will define which side will start the sequence.
Each step will last 30 minutes.
Aeration measured by Electric Impedance Tomography (EIT) and lung ultrasound, distribution of the lung ventilation and perfusion measured by EIT, ventilator and hemodynamic parameters, esophageal pressure, and blood gas analysis will be recorded at the end of each step.
Continuous monitoring of blood pressure, heart rate and saturation of arterial blood (SpO2) will be carried out during all steps of the protocol to assess the tolerance to the procedure.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Effects of a postural recruitment maneuver in lung aeration
Time Frame: Through study completion (up to 24 hours)
|
Lung aeration measured by ultrasound reaeration score, ranges from 0 (all regions are well aerated) to 36 (all regions are consolidated).
|
Through study completion (up to 24 hours)
|
Effects of a postural recruitment maneuver in distribution of ventilation
Time Frame: Through study completion (up to 24 hours)
|
Distribution of ventilation measured by EIT (distribution and changes in the impedance in AU, arbitray units)
|
Through study completion (up to 24 hours)
|
Effects of a postural recruitment maneuver in gas exchange
Time Frame: Through study completion (up to 24 hours)
|
Gas exchange measured by blood gas analysis (PaO2, PaCO2, in mmHg) and capnography (end-tidal CO2, in mmHg)
|
Through study completion (up to 24 hours)
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Effects of a postural recruitment maneuver in respiratory mechanics
Time Frame: Through study completion (up to 24 hours)
|
Respiratory mechanics measured by esophageal balloon (esophageal pressure, transpulmonary pressure, in cmH2O)
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Through study completion (up to 24 hours)
|
Effects of a postural recruitment maneuver in hemodynamic
Time Frame: Through study completion (up to 24 hours)
|
Hemodynamic data measured by invasive arterial monitoring (mean arterial pressure, in mmHg)
|
Through study completion (up to 24 hours)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility of a postural recruitment maneuver
Time Frame: Through study completion (up to 24 hours)
|
Oxigenatory tolerance evaluated with pulse oximeter (arterial oxygen saturation, in percentage)
|
Through study completion (up to 24 hours)
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Rollin Roldán, MD, Hospital Nacional Edgardo Rebagliati Martins
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
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)
July 17, 2020
Primary Completion (Actual)
September 30, 2020
Study Completion (Actual)
October 31, 2020
Study Registration Dates
First Submitted
July 14, 2020
First Submitted That Met QC Criteria
July 15, 2020
First Posted (Actual)
July 17, 2020
Study Record Updates
Last Update Posted (Actual)
August 25, 2021
Last Update Submitted That Met QC Criteria
August 23, 2021
Last Verified
August 1, 2021
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HNEdgardoRebagliatiMartins
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
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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