NCT02503241

Open Lung Strategy in Critically Ill Morbid Obese Patients

Open Lung Strategy in Critically Ill Morbid Obese Patients Lung Imaging and Heart-lung Interaction

• Status: Unknown
• Phase: N/A
• Study type: Interventional
• Enrollment: 21 (actual)
• Sponsor: Massachusetts General Hospital · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

The goal of this interventional crossover study in morbidly obese intubated and mechanically ventilated patients is to describe the respiratory mechanics and the heart-lung interaction at titrated positive end-expiratory pressure levels following a recruitment maneuver with transthoracic echocardiography and electric impedance tomography imaging.

Detailed description

Obese patients under mechanical ventilation are more likely to develop atelectasis as a consequence of the increased abdominal weight. Atelectasis is the primary responsible for respiratory insufficiency and impossibility to wean obese patients from respiratory support. In a previous study we demonstrated the efficacy of the application of titrated PEEP levels following a recruitment maneuver in obese patients, i.e. improvement in respiratory mechanics and gas exchanges without negative hemodynamic effects. The application of lung and heat imaging will allow us to quantitatively describe: * Increase in aerated lung tissue (reduction of atelectasis) * Reduction of over-inflation of the ventilated regions * Recoupling of ventilation and perfusion * Improvement in right heart function by reduction of right heart afterload

Conditions

• Obesity
• Respiratory Insufficiency
• Right-Sided Heart Failure
• Pulmonary Atelectasis
• Respiratory Mechanics

Interventions

Type	Name	Description
PROCEDURE	PEEP INCREMENTAL	PEEP was progressively increased by steps of 2 cmH2O every 60 second until the end-expiratory transpulmonary pressure became positive between 0-2 cmH2O.
PROCEDURE	PEEP DECREMENTAL	Lung recruitment maneuver (LRM) is a transitory and controlled increase in airway pressure to open collapsed alveoli. LRM is the first step of the PEEP DECREMENTAL method. After LRM, PEEP is systematically decreased, in small decrements, until the best respiratory system mechanics is identified.

Timeline

• Start date: 2016-04-01
• Primary completion: 2021-06-30
• Completion: 2022-06-30
• First posted: 2015-07-20
• Last updated: 2020-11-17

Locations

1 site across 1 country: United States