- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05876468
Effects of Continuous Anterior Chest Compression (StrapVent)
" Effects of Continuous Anterior Chest Compression (CACC) & Comparision With Prone Position in ARDS Patients " The StrapVent Study "
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Acute respiratory distress syndrome (ARDS) is usually characterized by inhomogeneous lesions, leading to an inhomogeneous distribution of the mechanical ventilation with the following several deleterious effects: atelectrauma of dependent posterior areas and overdistension in the anterior ones. Therefore, the gold standard treatment is to prevent VILI with lung protective ventilation : low tidal volume, high positive end expiratory pressure and prone positioning which is a technique that reduces mortality. Prone positioning has several beneficial effects : it relieves cardiac compression of the supporting lung, it stiffens the anterior chest wall thus limiting the risk of overdistension of anterior areas and promotes recruitment of non-dependent posterior pulmonary units. The overall effect is a more uniform distribution of transpulmonary pressures and improved ventilation to perfusion ratios.
Similar to prone positioning, continuous anterior chest wall compression stiffens the anterior chest wall. The investigators hypothesize that such reduction in anterior chest wall compliance may protect against overdistension and promote the redistribution of the ventilation in posterior areas.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Guillaume CARTEAUX, MD, PhD
- Phone Number: (+33) 01 45 17 86 38
- Email: guillaume.carteaux@aphp.fr
Study Locations
-
-
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Créteil, France, 94010
- Recruiting
- Assistance Publique Hôpitaux de Paris - CHU Henri Mondor
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18 ans
- Intubated moderate and severe ARDS according to the Berlin definition (PaO2/FiO2 ratio <= 200 mmHg)
- The patent must be sedated and paralyzed
- Informed consent from patient or family members
Exclusion Criteria:
- Extracorporeal membrane oxygenation (ECMO)
- Pneumothorax
- Thoracic trauma during the last 3 months
- Refractory shock
- Contraindication to EIT monitoring (e.g. burns, pacemaker, thoracic wounds limiting electrode belt placement)
- Pregnancy
- Any contra-indication to esophageal manometry (less than one month esophagus surgery, bronchopleural or esotracheal fistula, latex allergy)
- No social care
- Adults under Guardianship, curatorship or protection of the court
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: A description of each arm of the clinical trial that indicates its role in the clinical trial
Arm 1 Description: The study will consitent of recording the measurments of ventilatory settings, respiratory mechanics, flow and pressure curves, gaz exchange, haemodynamics and ventilation distribution in 5 consecutive conditions in adult patients with moderate to severe ARDS :
|
Patients with severe to moderate ARDS who were placed in prone position by the attending physician :
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The end inspiratory transpulmonary pressure (PL-insp) in centimetre of water
Time Frame: Through study completion (up to 6 hours)
|
The transpulmonary pressure will be measured by using an esophageal catheter connected to a differential pressure transducer.
The PL-insp will be calculated using the ratio between the elastance of the lung (El) and of the respiratory system (Ers) expressed in centimetre of water thanks to this formula PL-insp = Plateau pressure x (El/Ers).
The PL-insp between the different protocol conditions will be compared (After 16 hours of prone position, in supine position, 15mn after CACC with a pressure equal to the one observed in the prone position, 15mn after CACC with a pressure set at 60 - 80 cmH20, 15mn after taking off the CACC in supine position ).
CACC will be considered protective if there is a decrease in Pl-insp.
|
Through study completion (up to 6 hours)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Regional pulmonary compliances in centimetre of water
Time Frame: Through study completion (up to 6 hours)
|
Evaluation and comparison of pulmonary compliances in the different regions of interest (ROI) measured by Electrical Impedance Tomography (EIT) in the different protocol conditions.
|
Through study completion (up to 6 hours)
|
Lung mechanics : Airways pressure, Flow curves and Esophageal pressure
Time Frame: Through study completion (up to 6 hours)
|
Airways pressure (Paw) will be measured in cmH2O and recorded by the mean of a differential pressure transducer. Flow curves will be measured in L/mn and recorded by the mean of a pneumotachograph connected to the ventilator circuit. Esophageal pressure (Pes) will be measured in cmH2O and recorded thanks to an esophageal balloon catheter introduced in the mid-esophagus of the patient and connected to differential pressure transducer. Evaluation and comparison of respiratory mechanics in the different protocol conditions. |
Through study completion (up to 6 hours)
|
Pulmonary ventilation distribution in percentage
Time Frame: Through study completion (up to 6 hours)
|
Evaluation and comparison of the distribution of ventilation in the different regions of interest (ROI) measured by Electrical Impedance Tomography (EIT) in the different protocol conditions
|
Through study completion (up to 6 hours)
|
Recruitment-to-inflation (R/I) ratio
Time Frame: Through study completion (up to 6 hours)
|
Evaluation and comparaison of R/I in the different protocol conditions
|
Through study completion (up to 6 hours)
|
Hemodynamics
Time Frame: Through study completion (up to 6 hours)
|
Heart rate will be expressed in beats per minute, arterial blood pressure will be expressed in millimetre of mercury and norepinephrine perfusion will be expressed in milligrams per hour.
|
Through study completion (up to 6 hours)
|
Arterial blood gazes (ABG
Time Frame: Through study completion (up to 6 hours)
|
pH, PaCO2 and PaO2 will be measured by standard clinical technique using the ICU blood gaz analyzer.
PaCO2 and PaO2 will be expressed in millimetre of mercury.
|
Through study completion (up to 6 hours)
|
Incidence of CACC adverse events
Time Frame: Through study completion (up to 6 hours)
|
CACC will be interrupted if :
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Through study completion (up to 6 hours)
|
End expiratory lung impedance (EELZ) expressed in arbitrary units
Time Frame: Through study completion (up to 6 hours) ]
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Evaluation and comparison of EELZ using EIT in the different protocol conditions.
|
Through study completion (up to 6 hours) ]
|
Collaborators and Investigators
Investigators
- Principal Investigator: Guillaume CARTEAUX, MD, PhD, APHP
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
Keywords
Other Study ID Numbers
- APHP 211357
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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