Alveolar Recruitment Maneuvers, Intracerebral Hemodynamic and Oxygenation

NCT ID: NCT02574169

Last Updated: 2024-09-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

62 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-09-01

Study Completion Date

2025-12-31

Brief Summary

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This study aims to compare 2 alveolar recruitment maneuvers (ARM) in patients with cerebral injuries and acute respiratory distress syndrome (ARDS) in term of efficacy and tolerance.

Detailed Description

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Two ARM are compared in this study:

* The eSigh or extended sigh with increase of PEEP for 10 minutes to maintain plateau pressure at 40 cmH2O. During ARM, the peak pressure is limited to 50 cm H2O with decrease of tidal volume (Vt) if necessary.
* The continuous positive airway pressure, or Continuous Positive Airway Pressure (CPAP) with application of a positive pressure of 40 cm H2O for 40 seconds without tidal volume.

Patients are randomized to receive in cross-over 2 ARM: CPAP and Extended Sigh (eSigh). The following data: oxygen tissue partial pressure (PtiO2), respiratory parameters, systemic and intracerebral hemodynamic parameters are collected before, after 1 minute, 10 minutes and 60 minutes for each ARM.

Conditions

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Cerebral Injuries Acute Respiratory Distress Syndrome (ARDS)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Alveolar recruitment maneuvers Group 1

alveolar recruitment maneuvers by CPAP then alveolar recruitment maneuvers by eSigh

Group Type EXPERIMENTAL

alveolar recruitment maneuvers group 1

Intervention Type OTHER

Patients are randomized to receive in cross-over 2 ARM: CPAP at first and then eSigh.

The continuous positive airway pressure, or CPAP with application of a positive pressure of 40 cmH2O for 40 seconds without tidal volume.

The eSigh or extended sigh with increase of PEEP for 10 minutes to maintain plateau pressure at 40 cmH2O. During ARM, the peak pressure is limited to 50 cmH2O with decrease of tidal volume (Vt) if necessary.

The following data: PtiO2, respiratory parameters, systemic and intracerebral hemodynamic parameters are collected before, after 1 minute, 10 minutes and 60 minutes for each ARM.

Alveolar recruitment maneuvers Group 2

alveolar recruitment maneuvers by eSigh then alveolar recruitment maneuvers by CPAP

Group Type EXPERIMENTAL

alveolar recruitment maneuvers group 2

Intervention Type OTHER

Patients are randomized to receive in cross-over 2 ARM: eSigh at first and then CPAP.

The eSigh or extended sigh with increase of PEEP for 10 minutes to maintain plateau pressure at 40 cmH2O. During ARM, the peak pressure is limited to 50 cmH2O with decrease of tidal volume (Vt) if necessary.

The continuous positive airway pressure, or CPAP with application of a positive pressure of 40 cmH2O for 40 seconds without tidal volume.

The following data: PtiO2, respiratory parameters, systemic and intracerebral hemodynamic parameters are collected before, after 1 minute, 10 minutes and 60 minutes for each ARM.

Interventions

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alveolar recruitment maneuvers group 1

Patients are randomized to receive in cross-over 2 ARM: CPAP at first and then eSigh.

The continuous positive airway pressure, or CPAP with application of a positive pressure of 40 cmH2O for 40 seconds without tidal volume.

The eSigh or extended sigh with increase of PEEP for 10 minutes to maintain plateau pressure at 40 cmH2O. During ARM, the peak pressure is limited to 50 cmH2O with decrease of tidal volume (Vt) if necessary.

The following data: PtiO2, respiratory parameters, systemic and intracerebral hemodynamic parameters are collected before, after 1 minute, 10 minutes and 60 minutes for each ARM.

Intervention Type OTHER

alveolar recruitment maneuvers group 2

Patients are randomized to receive in cross-over 2 ARM: eSigh at first and then CPAP.

The eSigh or extended sigh with increase of PEEP for 10 minutes to maintain plateau pressure at 40 cmH2O. During ARM, the peak pressure is limited to 50 cmH2O with decrease of tidal volume (Vt) if necessary.

The continuous positive airway pressure, or CPAP with application of a positive pressure of 40 cmH2O for 40 seconds without tidal volume.

The following data: PtiO2, respiratory parameters, systemic and intracerebral hemodynamic parameters are collected before, after 1 minute, 10 minutes and 60 minutes for each ARM.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients with brain injuries (subarachnoid hemorrhage, traumatic brain injury, ischemic and hemorrhagic stroke)
* Patients with moderate and severe ARDS criteria (as defined by classification of Berlin)
* Patients under mechanical ventilation

Exclusion Criteria

* ICP (Intracranial pressure) \> 25 mmHg
* Pregnant women
* Patients with history of chronic respiratory disease
* Patients with bronchopleural fistula
* Patients with hemodynamic instability despite appropriate measures
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Toulouse

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ségolène MROZEK, MD

Role: PRINCIPAL_INVESTIGATOR

UH TOULOUSE

Locations

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UH Toulouse

Toulouse, Midi Pyrénées, France

Site Status RECRUITING

UH Caen

Caen, , France

Site Status RECRUITING

UH Clermont-Ferrand

Clermont-Ferrand, , France

Site Status RECRUITING

UH Montpellier

Montpellier, , France

Site Status RECRUITING

UH Nantes

Nantes, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Ségolène MROZEK, MD

Role: CONTACT

05 61 77 21 67 ext. +33

Audrey Tomasik

Role: CONTACT

05 61 77 85 97

Facility Contacts

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Ségolène MROZEK, MD

Role: primary

05 61 77 21 67 ext. +33

Thomas GEERAERTS, MD

Role: backup

05 61 77 21 00 ext. +33

Ségolène MROZEK, MD

Role: backup

Thomas GEERAERTS, MD

Role: backup

Béatrice RIU, MD

Role: backup

Marc-Olivier FISCHER, MD

Role: primary

02 31 06 33 03 ext. +33

Rusell CHABANNE, MD

Role: primary

04 73 75 16 48 ext. +33

Jean-Michel CONSTANTIN, MD

Role: backup

04 73 75 05 01 ext. +33

Pierre-François PERRIGAUT

Role: primary

04 67 33 76 87 ext. +33

Antoine ROQUILLY, MD

Role: primary

02 40 08 30 08 ext. +33

References

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Constantin JM, Jaber S, Futier E, Cayot-Constantin S, Verny-Pic M, Jung B, Bailly A, Guerin R, Bazin JE. Respiratory effects of different recruitment maneuvers in acute respiratory distress syndrome. Crit Care. 2008;12(2):R50. doi: 10.1186/cc6869. Epub 2008 Apr 16.

Reference Type BACKGROUND
PMID: 18416847 (View on PubMed)

Rangel-Castilla L, Gopinath S, Robertson CS. Management of intracranial hypertension. Neurol Clin. 2008 May;26(2):521-41, x. doi: 10.1016/j.ncl.2008.02.003.

Reference Type BACKGROUND
PMID: 18514825 (View on PubMed)

Chesnut RM. Care of central nervous system injuries. Surg Clin North Am. 2007 Feb;87(1):119-56, vii. doi: 10.1016/j.suc.2006.09.018.

Reference Type BACKGROUND
PMID: 17127126 (View on PubMed)

Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010 Mar 3;303(9):865-73. doi: 10.1001/jama.2010.218.

Reference Type BACKGROUND
PMID: 20197533 (View on PubMed)

Other Identifiers

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RC31/15/7604

Identifier Type: -

Identifier Source: org_study_id

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