Respiratory Distress Syndrome, Adult Clinical Trial
Official title:
Effects of Positive End-expiratory Pressure and Tidal Volume on Fluid Responsiveness of Acute Respiratory Distress Syndrome.
Fluid responsiveness (FR)refers to the ability of heart to increase its stroke volume in response to volume load.Low tidal volume and high PEEP exerts contrast effect on the prediction of fluid responsiveness, the aim of this study is to compare the relative predicting power of the dynamic preload indicator (PPV, SVV), passive leg raising test, and pleth variability index (PVI) on the fluid responsiveness of acute respiratory distress syndrome ventilated with various PEEP levels or various tidal volumes.
In septic critically ill mechanically ventilated patients with acute circulatory failure,
inadequate volume resuscitation leads to multiple organ failure. Early goal-directed therapy
emphasizes early and aggressive hemodynamic support in patients with severe sepsis and septic
shock. On the other hand, because of increased microvascular permeability and capillary
leakage, conservative fluid management and more aggressive restriction in fluid accumulation
to reduce lung water and tissue edema has been suggested by acute respiratory distress
syndrome net. Fluid responsiveness refers to the ability of the heart to increase its stroke
volume in response to volume load. Accurately predicting volume responsiveness will be
beneficial in obviating the need for unnecessary fluid loading, and in detecting patients who
may benefit from a volume load.
By inducing cyclic changes in pleural and transpulmonary pressure, mechanical ventilation
results in cyclic changes in the preload and afterload, and therefore, the cyclic variation
in systolic and pulse pressure. Recently, a systemic review concluded that dynamic preload
indicator [pulse pressure variation (PPV), stroke volume variation (SVV)] are highly accurate
in predicting volume responsiveness in critically ill patients. However, this technique is
limited to patients who receive controlled ventilation with adequate tidal volume (> 8 ml/Kg)
and sedation or paralysis is needed to abolish the spontaneous ventilation.
For acute respiratory distress syndrome patients, protective ventilatory strategy suggested
low tidal volume to 6 ml/Kg. On the contrary, high PEEP needed for acute respiratory distress
syndrome to prevent VALI induces a leftward shift to the steep pat of the Frank-Starling
curve and increase the fluid responsiveness. Whether the dynamic preload indicators (PPV and
SVV) are still effective in acute respiratory distress syndrome patients for predicting fluid
responsiveness remain controversial.
Passive leg raising (PLR), by inducing a gravitational transfer of blood from the lower part
of the body toward the central circulatory compartment, can be considered as a brief "self
volume challenge". Recently, a systemic review and meta-analysis concluded that PLR-induced
changes in cardiac output reliably predict fluid responsiveness regardless of ventilation
mode, underlying cardiac rhythm and technique of measurement and can be recommended for
routine assessment of fluid responsiveness in the majority of ICU population. More
importantly, this prediction remains very valuable in patients with cardiac arrhythmias or
spontaneous breathing activity.
Respiratory variations in the pulse oximeter plethysmographic waveform amplitude (ΔPOP) have
been shown to be able to predict fluid responsiveness in mechanically ventilated patients.
The main advantage of this index is that it is noninvasive, widely available, and
inexpensive. Perfusion index (PI), the percentage between the infrared pulsatile and
nonpulsatile signal, reflects the amplitude of the pulse oximeter waveform. Recently, Pleth
Variability Index (PVI), derived from perfusion index, affords a continuous monitoring of
ΔPOP. PVI has been shown to be correlated to ΔPOP and PPV and has been demonstrated to be
equivalent to SVV as a predictor of fluid responsiveness in ventilated patients during major
surgery. However, whether the PVI can predict the fluid responsiveness in acute respiratory
distress syndrome necessitating low tidal volume and high PEEP is not clear.
Because of the aforementioned contrasting effects of low tidal volume and high PEEP on the
prediction of fluid responsiveness, the aim of this study is to compare the relative
predicting power of the dynamic preload indicator (PPV, SVV), passive leg raising test, and
PVI on the fluid responsiveness of acute respiratory distress syndrome ventilated with
various PEEP levels or various tidal volumes.
;
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT03712215 -
STUDY OF ELECTRICAL STIMULATION IN PULMONARY FUNCTION IN INTENSIVE CARE UNIT
|
N/A | |
Completed |
NCT04582201 -
Evaluate the Safety of agenT-797 in Participants With Moderate to Severe Difficulty Breathing Secondary to SARS-CoV-2
|
Phase 1/Phase 2 | |
Recruiting |
NCT01990456 -
Strategies for Optimal Lung Ventilation in ECMO for ARDS: The SOLVE ARDS Study
|
N/A | |
Completed |
NCT01167621 -
Changes in Refractory Acute Respiratory Distress Syndrome (ARDS) Patients Under High Frequency Oscillation-ventilation
|
N/A | |
Terminated |
NCT00233207 -
IC14 Antibodies to Treat Individuals With Acute Lung Injury
|
Phase 2 | |
Completed |
NCT00029328 -
Etanercept for Non-Infectious Lung Injury Following Bone Marrow Transplantation
|
Phase 1/Phase 2 | |
Completed |
NCT00004494 -
Phase I Study of Vasoactive Intestinal Peptide in Patients With Acute Respiratory Distress Syndrome and Sepsis
|
Phase 1 | |
Completed |
NCT00000579 -
Acute Respiratory Distress Syndrome Clinical Network (ARDSNet)
|
Phase 3 | |
Recruiting |
NCT03236272 -
Establishment of a Biomarkers-based Early Warning System of Acute Respiratory Distress Syndrome (ARDS)
|
||
Withdrawn |
NCT04508933 -
Comparison of Extra Vascular Lung Water Index in Covid-19 ARDS and "Typical"ARDS Patients
|
||
Completed |
NCT02273687 -
Time-motion-mode Ultrasound Diaphragm Measures in Patients With Acute Respiratory Distress in Emergency Department
|
N/A | |
Recruiting |
NCT03424798 -
Measuring Heart and Lung Function in Critical Care
|
N/A | |
Recruiting |
NCT01992237 -
Measuring Energy Expenditure in ECMO (Extracorporeal Membrane Oxygenation) Patients
|
N/A | |
Completed |
NCT00719446 -
Evaluating Health Outcomes and QOL After ALI Among Participants of the ALTA, OMEGA, EDEN, and SAILS ARDS Network Trials
|
N/A | |
Completed |
NCT00236262 -
Effect of Positive Expiratory Pressure on Right Ventricular Function in Patients With Respiratory Distress Syndrome
|
N/A | |
Completed |
NCT00300248 -
Long-Term Results in Mechanically Ventilated Individuals With Acute Lung Injury/Acute Respiratory Distress Syndrome
|
N/A | |
Completed |
NCT00157144 -
Australia and New Zealand Adult Extracorporeal Membrane Oxygenation (ECMO) Audit 2005
|
N/A | |
Completed |
NCT00141726 -
Study of Enbrel (Etanercept) for the Treatment Sub-Acute Pulmonary Dysfunction After Allogeneic Stem Cell Transplant
|
Phase 2 | |
Recruiting |
NCT00465374 -
A Validation/Interventional Study on Stress Index in Predicting Mechanical Stress in ARDS Patients
|
Phase 3 | |
Completed |
NCT00094406 -
Carbon Monoxide to Prevent Lung Inflammation
|
Phase 1 |