Effects of Continuous Anterior Chest Compression (StrapVent)

Assistance Publique - Hôpitaux de Paris

Status: Enrolling

Conditions: Evaluable

Treatments: Device: Continuous anterior chest compression

Study type: Interventional

Funder types: Other

Identifiers

NCT05876468

APHP 211357

Details and patient eligibility

About

The aim is to test the physiological effects of continuous anterior chest compression in patients with severe to moderate ARDS.

Full description

Acute respiratory distress syndrome (ARDS) is usually characterized by inhomogeneous lesions, leading to an inhomogeneous distribution of the mechanical ventilation with the following several deleterious effects: atelectrauma of dependent posterior areas and overdistension in the anterior ones. Therefore, the gold standard treatment is to prevent VILI with lung protective ventilation : low tidal volume, high positive end expiratory pressure and prone positioning which is a technique that reduces mortality. Prone positioning has several beneficial effects : it relieves cardiac compression of the supporting lung, it stiffens the anterior chest wall thus limiting the risk of overdistension of anterior areas and promotes recruitment of non-dependent posterior pulmonary units. The overall effect is a more uniform distribution of transpulmonary pressures and improved ventilation to perfusion ratios.

Similar to prone positioning, continuous anterior chest wall compression stiffens the anterior chest wall. The investigators hypothesize that such reduction in anterior chest wall compliance may protect against overdistension and promote the redistribution of the ventilation in posterior areas.

Enrollment: 20 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age ≥ 18 ans
• Intubated moderate and severe ARDS according to the Berlin definition (PaO2/FiO2 ratio <= 200 mmHg)
• The patent must be sedated and paralyzed
• Informed consent from patient or family members

Exclusion criteria

• Extracorporeal membrane oxygenation (ECMO)
• Pneumothorax
• Thoracic trauma during the last 3 months
• Refractory shock
• Contraindication to EIT monitoring (e.g. burns, pacemaker, thoracic wounds limiting electrode belt placement)
• Pregnancy
• Any contra-indication to esophageal manometry (less than one month esophagus surgery, bronchopleural or esotracheal fistula, latex allergy)
• No social care
• Adults under Guardianship, curatorship or protection of the court

Trial design

Primary purpose: Basic Science

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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20 participants in 1 patient group

A description of each arm of the clinical trial that indicates its role in the clinical trial

Experimental group

Description:

Arm 1 Description: The study will consitent of recording the measurments of ventilatory settings, respiratory mechanics, flow and pressure curves, gaz exchange, haemodynamics and ventilation distribution in 5 consecutive conditions in adult patients with moderate to severe ARDS : * After 16 hours of prone position * In supine position 1 hour after the prone position * 15mn after CACC with a pressure equal to the one observed in the prone position * 15mn after CACC with a pressure set at 60 - 80 cmH20 * 15mn after taking of the CACC

Treatment:

Device: Continuous anterior chest compression