Personalized Tidal Volume in ARDS (VT4HEMOD)
Treatment of acute respiratory distress syndrome (ARDS) relies on invasive mechanical ventilation with supposedly protective settings (low tidal volume ventilation). Mortality of ARDS remains high in observational studies (40 to 50%). Approximately 30% of ARDS patients exhibit tidal hyperinflation despite low tidal vol
| Condition(s) | Acute Respiratory Distress Syndrome |
|---|---|
| Status | Recruiting |
| Phase | NA |
| Study type | Interventional |
| Summary | Treatment of acute respiratory distress syndrome (ARDS) relies on invasive mechanical ventilation with supposedly protective settings (low tidal volume ventilation). Mortality of ARDS remains high in observational studies (40 to 50%). Approximately 30% of ARDS patients exhibit tidal hyperinflation despite low tidal volume ventilation, suggesting that personalization of tidal volume is required to improve ARDS prognostic. To date, reliable bedside tools to adjust tidal volume are lacking. Excessive tidal volume can be detected using computed tomography by quantification of tidal hyperinflation, but this technique is reserved to research studies and requires patient transport to imaging facility. Mechanical ventilation generates cardio-pulmonary interaction, whose magnitude is influenced by |
| Who can participate | Inclusion Criteria: 1. Age greater then 18 years old 2. ARDS according to the BERLIN definition with PaO2/FiO2 ratio ≤ 150 mm Hg 3. invasive mechanical ventilation in volume controlled mode with tidal volume set to 6 ml/kg predicted body weight 4. use of sedation and neuromuscular-blocking agents 5. arterial catheter allowing computation of pulse contour cardiac output calibrated with thermodilution 6. central venous catheter implanted in the superior vena cava territory 7. esophageal balloon 8. Computed tomography planned by attending physician Exclusion Criteria: 1. Previous inclusion in current study 2. Acute cor pulmonale 3. ECMO 4. Arterial pH \< 7.21 despite respiratory rate set to a maximum of 35/min 5. Pneumothorax or bronchopleural fistula 6. Decision to withdraw or withhold life |
| Ages | 18 Years |
| Sex | All |
| Lead sponsor | Hospices Civils de Lyon |
| Locations | Lyon, France |
| Start date | 2022-12-29 |
| NCT ID | NCT05406570 |
| Official listing | https://clinicaltrials.gov/study/NCT05406570 |