Informations générales (source: ClinicalTrials.gov)
Avalanche Phenomenon During Airways Opening in Acute Respiratory Distress Syndrome (AVALANCHE)
Observational [Patient Registry]
Poitiers University Hospital (Voir sur ClinicalTrials)
mars 2022
septembre 2023
29 juin 2024
Acute respiratory distress syndrome accounts for 23% of mechanically ventilated patients
and is associated with high mortality rate. Although life-saving, mechanical ventilation
may worsen lung injury through two main mechanisms: lung overdistension and atelectrauma.
Indeed, the cyclic opening and closure of airways during tidal ventilation may cause lung
and bronchial injuries as suggested by animal models and autopsy findings. Complete
airways closure has recently been described in 40% of patients with acute respiratory
distress syndrome, and setting positive end-expiratory pressure above the airway opening
pressure may limit atelectrauma. However, animal and mathematical models suggest that
above the airway opening pressure, more distal airways open unevenly according to their
own opening pressure, resulting in an "avalanche"-like phenomenon during lung inflation.
This phenomenon has never been described in humans. A better understanding of the opening
of airways in acute respiratory distress syndrome may help to limit ventilation-induced
lung injury and to improve outcomes.
Etablissements
| Les établissements sans correspondance certaine dans le répertoire FINESS dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données | |||||
|---|---|---|---|---|---|
| CHU Poitiers - 86000 - Poitiers - France | Rémi COUDROY, Pr | Contact (sur clinicalTrials) | |||
Critères
Tous
Inclusion Criteria:
- Age ≥ 18
- Moderate-to-severe acute respiratory distress syndrome within the first 72 hours
after meeting the Berlin definition criteria:
- Within 1 week of a known clinical insult or new or worsening respiratory symptoms;
- Bilateral opacities (not fully explained by effusions, lobar/lung collapse, or
nodules);
- Respiratory failure not fully explained by cardiac failure or fluid overload;
- PaO2/FiO2 ≤ 200 mmHg with positive end-expiratory pressure ≥ 5 cmH2O.
- Absence of spontaneous breathing efforts
- Consent to participate to the study from the patient and/or its surrogate
- Age ≥ 18
- Moderate-to-severe acute respiratory distress syndrome within the first 72 hours
after meeting the Berlin definition criteria:
- Within 1 week of a known clinical insult or new or worsening respiratory symptoms;
- Bilateral opacities (not fully explained by effusions, lobar/lung collapse, or
nodules);
- Respiratory failure not fully explained by cardiac failure or fluid overload;
- PaO2/FiO2 ≤ 200 mmHg with positive end-expiratory pressure ≥ 5 cmH2O.
- Absence of spontaneous breathing efforts
- Consent to participate to the study from the patient and/or its surrogate
- Pneumothorax
- Broncho-pleural fistula
- Tracheostomy
- Hemodynamic instability
- Severe hypoxemia
- Suspected of proven intracranial hypertension
- Chronic obstructive lung disease
- Pacemaker or defibrillator
- Decision to withhold of withdraw life-sustaining measures
- Under protection