Assessing Right Ventricular Injury in ARDS Patients Using EIT and PEEP Titration

Ventilator-induced Right Ventricular Injury During Electrical Impedance Tomography-based Positive End-expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome: a Pilot Physiological Study.

This study is testing if adjusting breathing support levels can improve heart function in patients with severe lung issues caused by ARDS.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 20 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of Padova (Academic / other)
• Locations: 1 site (Padua)
• Trial ID: NCT05583461 on ClinicalTrials.gov

What this trial studies

This trial investigates the impact of different levels of positive end-expiratory pressure (PEEP) on right ventricular function in patients with moderate to severe acute respiratory distress syndrome (ARDS). Using electrical impedance tomography (EIT), the study aims to optimize PEEP settings to minimize lung overdistension and atelectasis, which can exacerbate right ventricular dysfunction. Participants will undergo transthoracic echocardiography to evaluate changes in right ventricular size and function during controlled mechanical ventilation. The study employs a randomized crossover design to compare the effects of standard PEEP versus EIT-guided PEEP titration.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older diagnosed with moderate to severe ARDS within 72 hours of onset.

Not a fit: Patients with contraindications to mechanical ventilation or electrical impedance tomography, such as those with active air leaks or certain electronic devices, may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to improved management of right ventricular function in ARDS patients, potentially reducing mortality rates.

How similar studies have performed: While the approach of using EIT for PEEP titration is innovative, similar studies have shown promising results in optimizing mechanical ventilation strategies for ARDS.

Eligibility criteria

Inclusion criteria:

1. Moderate to severe acute respiratory distress syndrome
2. Inclusion within 72 hours of acute respiratory distress syndrome diagnosis
3. Endotracheal intubation or tracheostomy

Exclusion criteria:

1. Age lower than 18 years old
2. Pregnancy
3. Absence of informed consent
4. Thoracic surgery or lung transplant during the admission
5. Contraindications to recruitment maneuvers (mean arterial pressure lower than 65 mmHg despite administration of fluids or vasopressors, active air leaks through a chest tube, pneumothorax or subcutaneous or mediastinal emphysema in absence of chest drainage)
6. Contraindications to electrical impedance tomography (contraindication to recruitment maneuvers, presence of pacemakers or other electronic devices in the chest, injuries or burns in the electrode placement area)

Where this trial is running

Padua

• University Hospital of Padua — Padua, Italy (Recruiting)

Study contacts

• Principal investigator: Tommaso Pettenuzzo, MD — Institute of Anesthesiology and Intensive Care, Padova University Hospital
• Study coordinator: Tommaso Pettenuzzo, MD

Conditions Acute Respiratory Distress Syndrome; Right Ventricular Dysfunction; Acute respiratory distress syndrome; Mechanical ventilation; Right ventricular dysfunction; Positive end-expiratory pressure; Electrical impedance tomography; Echocardiography