Acute Cor Pulmonale Clinical Trial
Official title:
The Prospective Observational Study of ARDS Related Acute CorPulmonale and the Randomized Controlled Study of ARDS Aimed Circulation Protection China (ACPC)
The investigators established a national cohort of Chinese ARDS with Acute CorPulmonale to
enable prospective observational studies. The goals are the following.
First, morbidity and mortality rate of ARDS with ACP in the ICU across Chinese mainland.
Second, forming the diagnostic ultrasound strategy of ARDS-ACP, namely TRIP procedures. And
predictive value of diagnostic strategy for ACP or prognosis of ACP were calculated.
Third, comparison of ventilator parameters for ACP and non-ACP or survivor and non-survisors,
which reaveald that of inappropriate mechanical ventilation on circulation and prognosis.
Screening for risk factors of ARDS with ACP.
Acute respiratory distress syndrome (ARDS) is an acute and critical illness characterized by
progressive dyspnea and refractory hypoxemia caused by intrapulmonary or extrapulmonary
factors. The mortality rate of ARDS is extremely high. ACP caused by pulmonary circulatory
disorder is its main clinical feature, which is related to the severity of lung injury in
ARDS patients. It has been recognized that the ACP is an independent risk factor for the
prognosis of patients with ARDS. Positive pressure mechanical ventilation is an important
ARDS treatment strategy for ARDS. Especially the lung protective ventilation strategy with
"small tidal volume and increased PEEP" as the core content, which achieved a milestone of
lower the mortality of ARDS. However, improper use of positive pressure mechanical
ventilation can increase right ventricular load and increase mortality in ARDS patients.
Therefore, understanding the effect of positive pressure mechanical ventilation on right
heart function in patients with ARDS is important for prevention and treatment for the ACP of
ARDS and reduction of ARDS mortality.
The alveolar edema, alveolar collapse, and hypoxic pulmonary vasoconstriction loss caused by
increased pulmonary vascular permeability and release of inflammatory mediators resulted in
loss of ventilation/blood flow, severe hypoxemia, pulmonary vasospasm, pulmonary
microthrombus formation, which increased pulmonary arterial pressure and even APC. Positive
pressure mechanical ventilation maintains alveolar ventilation through positive airway
pressure, prevents premature alveolar collapse by positive end expiratory pressure (PEEP),
changes intrathoracic pressure and lung volume, and affects the right ventricle load.
Different studies have found that the incidence of ACP in patients with ARDS is from 22% to
60%. Jardin, et al found that patients with ARDS had a significant increase in ACP and
mortality when the airway pressure was greater than 26 cmH2O, which revealed that the
difference in positive pressure mechanical ventilation settings has a significant difference
in the right heart function of ARDS patients. Mekontso, et al propose a simple clinical risk
score for early identification of ACP included pneumonia as cause of ARDS, driving pressure
≥18cmH2O, PaO2/FiO2 ratio<150 mmHg, and PaCO2≥48mmHg. However, for the morbidity and
mortality of ACP in ARDS, the related risk factors and criteria are different due to the
influence of the different etiology of ARDS and the different study time. For these reasons,
the investigators established a national cohort of Chinese ARDS with Acute CorPulmonale to
enable prospective observational studies.
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