Paradoxical Response to Chest Wall Loading in Mechanically Ventilated Patients

HealthPartners Institute

Status: Withdrawn

Conditions: Mechanical Ventilation Pressure High; COVID-19; Ventilator-Induced Lung Injury; ARDS

Treatments: Diagnostic Test: Manual loading of the chest wall

Study type: Interventional

Funder types: Other

Identifiers

NCT06093958

A21-280

Details and patient eligibility

About

The purposes of our study are to: 1) determine the incidence of paradoxical response to chest wall loading in mechanically ventilated patients; 2) identify sub-populations in which it is most likely to occur (e.g., severe ARDS); and 3) standard the bedside procedure for demonstrating this physiology.

Full description

Mechanical ventilation can be a life-saving intervention for patients with respiratory failure, but the acutely injured lung is vulnerable to further damage if positive pressure ventilation is not employed judiciously. "Lung protective ventilation" encompasses a group of practices intended to minimize ventilator-induced lung injury (VILI) and includes the delivery of low tidal volumes (to minimize dynamic lung strain) and the prevention of injuriously high airway pressures (to minimize lung stress). The prone position, which compresses (or "loads") the chest wall, more evenly distributes volume and pressure, mitigates the damaging effects of stress/strain, and improves clinical outcomes in patients with severe respiratory failure from adult respiratory distress syndrome (ARDS).

Chest wall loading would not be expected to produce these beneficial effects in the supine position-quite the opposite; it usually results in net volume loss and higher airway pressures in response to an unchanging tidal volume. A paradoxical response to chest wall loading, leading to decreased airway pressures, however, was recently reported in a group of patients with advanced lung disease secondary to COVID-19. In this cohort, a paradoxical decrease in airway pressures was elicited during a brief period of manual compression of the abdomen.

This maneuver, which is non-invasive, free of cost, and gives real-time information, may have important diagnostic (and potentially therapeutic) implications for ventilator management in patients with respiratory failure.

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria: Non-surgical patients admitted to the ICU at Regions Hospital (St. Paul, MN) or Methodist Hospital (St. Louis Park, MN), receiving mechanical ventilation for any reason, and breathe passively during mechanical ventilation

Exclusion Criteria:

1. Age < 18 years old
2. Pregnancy at the time of their inclusionary hospitalization
3. Recent (< 30 days) abdominal or chest wall surgery (including spine)
4. Recent (< 30 days) abdominal or chest wall trauma (including spine)
5. Traumatic brain injury, intracranial bleed, or recent neurologic surgery
6. Family member or representative not available to provide informed consent
7. Not passive while receiving mechanical ventilation support
8. Hemodynamic instability

Trial design

Primary purpose: Diagnostic

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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0 participants in 1 patient group

Chest wall loading

Experimental group

Description:

All patients who are receiving mechanical ventilation and are passive on the ventilator will have chest wall loading performed to identify whether there is a paradoxical decrease in lung compliance.

Treatment:

Diagnostic Test: Manual loading of the chest wall