An interventional study of decrease the positive end expiratory pressure (PEEP) and mechanical features assessment in Mechanical Ventilation Complication, sponsored by University of Bari. Completed at 1 site in Italy. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-01-21.
Sponsored by University of Bari · Not applicable, Interventional, and Prevention
The perfusion of the deeply different areas coexisting in ARDS lung generates two type of venus-admixure : true shunt and shunt effect. Briefly, true shunt and shunt effect are related to non-aerated and poorly-ventilated lung areas perfusion respectively. Practically, it is not possible to quantify the true shunt and the shunt-effect directly, but we can measure the "total-shunt", i.e. the sum of two kind of venus-admixured. As it is known from classical physiology, the effects of FiO2 variations on PaO2 are deeply different depending on the type of venous admixures. In the case of a patient with virtually only true shunt, any FiO2 variation will not modify the PaO2. On the other hand, in a patient with virtually only a shunt effect, increasing the FiO2 the PaO2 will progressively increase. Indeed, ventilating a patient presenting only a shunt effect (without true shunt) with pure oxygen will generate a "normal" P/F ratio. In patients ventilated with high PEEP levels it is difficult to predict based on the P/F ratio the relative amount of true shunt and shunt effect. However, patients presenting a significant shunt effect when ventilated with higher PEEP level would likely have "unstable" poorly aerated lung areas that need PEEP to remain opened. In those patients, a PEEP-weaning protocol based on the P/F ratio could induce significant alveolar de-recruitment and clinical deterioration. On the contrary, patients with less shunt effect would be likely less prone to alveolar de-recruitment and would benefice from PEEP decrease.
the investigators set up a study to test the hypothesis that patients presenting a significant shunt effect when ventilated with higher PEEP levels could be prone to significant alveolar de-recruitment at the PEEP weaning attempt. To do so, the investigator has to measure the total shunt at higher PEEP level in patients ready to be weaned from the PEEP (according to the Mercat protocol), at three FiO2 levels (i.e. 0,3, 0,6 and 1). The shunt effect is quantified as the difference in total shunt between FiO2 0,3 and .The hypothesis of this study is that the shunt effect could predict alveolar de-recruitment when weaning PEEP.
University of Bari is the lead sponsor of 75 studies on the registry; 12 are open to participants now.
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Exclusion Criteria:
patient ventilated fixing high level of positive end expiratory pressure
Other: decrease the positive end expiratory pressure (PEEP) · Other: mechanical features assessment · Other: shunt assessment
patient ventilated fixing low level of positive end expiratory pressure
Other: mechanical features assessment · Other: shunt assessment
decrease the PEEP going from high (according to ExPress Trial) to low level
evaluation of the mechanical features of respiratory system
evaluation of the pulmonary shunt during two different ventilation setting
de-recruitment
the shunt effect cold predict the lung de-recruitment volume
Time frame: decreasing PEEP from high to low levelthrough study completion, an average of 2 years
This study is completed, as verified in Jan 2022. You cannot join it, but the record below documents what was studied.
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University of Bari