Effect of PEEP and Trendelenburg on Ultrasound Size of Internal Jugular and Subclavian Veins (PEEPUS)

University Hospital, Clermont-Ferrand

Status: Completed

Conditions: Management of the Expiratory End-expiratory Pressure (PEEP) and Body Position; Ventilated Patient in Intensive Care

Treatments: Behavioral: Patient's position

Study type: Interventional

Funder types: Other

Identifiers

NCT02569424

2015-A00606-43 (Registry Identifier)

CHU-0246

Details and patient eligibility

About

There is no recommendation for the management of the positive end-expiratory pressure (PEEP) during setting of a central venous catheter (CVC) in a ventilated patient. Several non-randomized studies have investigated the cross-sectional area (AST) ultrasound minor axis for different pressure levels by evaluating a single vessel every time or by not displaying the right or left side in the evaluation. Another study showed that there could be unpredictable size differences between the 2 subclavian veins.

In ventilated patient, the PEEP, which is intrathoracic, will result in a decrease of venous return and thus possibly a superior vena cava dilation, located outside the pleura, depending on their capacitance. Different pressure levels showed an increase of AST with the increase of intra-thoracic pressure on certain veins, in a heterogeneous and not randomized manner.

The primary purpose of the study is to measure the effect of PEEP (0, 5, 10 or 15 cm H2O) and the patient's position (supine or Trendelenburg strict -15-20 °) on the cross-sectional area of the jugular and subclavian veins.

Full description

There is no recommendation for the management of the positive end-expiratory pressure (PEEP) during setting of a central venous catheter (CVC) in a ventilated patient. Several non-randomized studies have investigated the cross-sectional area (AST) ultrasound minor axis for different pressure levels by evaluating a single vessel every time or by not displaying the right or left side in the evaluation. Another study showed that there could be unpredictable size differences between the 2 subclavian veins.

In ventilated patient, the PEEP, which is intrathoracic, will result in a decrease of venous return and thus possibly a superior vena cava dilation, located outside the pleura, depending on their capacitance. Different pressure levels showed an increase of AST with the increase of intra-thoracic pressure on certain veins, in a heterogeneous and not randomized manner.

The primary purpose of the study is to measure the effect of PEEP (0, 5, 10 or 15 cm H2O) and the patient's position (supine or Trendelenburg strict -15-20 °) on the cross-sectional area of the jugular and subclavian veins.

Enrollment: 42 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Any patient ventilated in intensive care is eligible.
• Age ≥ 18 years
• Patient with stable hemodynamic status and Mean Blood Pressure (< 65 mmHg)
• Patient with registered social security number

Exclusion criteria

• clinical sign for a central venous thrombosis (unilateral edema ...).during echography screening before inclusion
• presence of a central line for more than 48 hours.
• Anechoic patient (checked during echography screening)
• History of cervical spine surgery.
• IntraCranial HyperTension
• patient in shock with hemodynamic instability and not stabilized
• patient treated by noradrenaline > 1 µg/kg/min
• patient or relative's refusal
• protected patients ≥ 18 years, minors, pregnant women

Trial design

Primary purpose: Prevention

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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42 participants in 1 patient group

ventilated patients

Experimental group

Description:

Patient's position (Supine or Trendelenburg strict -20°)

Treatment:

Behavioral: Patient's position