V/Q Matching Variations With PEEP in ARDS According to Compliance-based Phenotypes (France)
NCT ID: NCT05578742
Last Updated: 2025-12-08
Study Results
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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RECRUITING
NA
50 participants
INTERVENTIONAL
2024-02-08
2026-09-30
Brief Summary
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Detailed Description
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The dissociation between mechanics and hypoxemia may be related to a specific diversity in the pattern of ventilation-perfusion matching (V/Q matching) among patients with normal compliance and ARDS. In patients with low compliance, V/Q mismatch may be characterized by right-to-left shunt, secondary to collapse of the gravity-dependent regions; while, in patients with normal compliance, V/Q mismatch may show a redistribution of blood flow to hypo-ventilated lung areas by larger dead space and impaired hypoxic vasoconstriction.
These differences may also influence the response to PEEP in terms of gas exchange and lung protection . It may also explain the failure for high PEEP levels to improve significantly mortality in the global ARDS population (i.e., with patients' selection only based on hypoxemia).
Electrical Impedance Tomography (EIT) is a device allowing to assess ventilation and perfusion distribution. Thus, EIT can be used to evaluate global and regional V/Q matching, and could be used to understand mechanisms of hypoxemia, especially in patients with normal mechanics and ARDS.
The aim of this study is to assess V/Q matching according to these different ARDS phenotypes, and to evaluate the effects of PEEP in each one.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
Then, patients will be randomized and allocated to one of the following strategies:
* Strategy A: PEEP 15 cmH2O → PEEP 5 cmH2O
* Strategy B: PEEP 5 cmH2O → PEEP 15 cmH2O
A parallel study will be conducted in Italy, to reach 50 more patients. Data will be shared between these two studies.
TREATMENT
NONE
Study Groups
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Strategy A: PEEP 15 cmH2O → PEEP 5 cmH2O
PEEP decrease
Positive End Expiratory Pressure (PEEP) will be decreased from 15 to 5 cmH2O.
Strategy B: PEEP 5 cmH2O → PEEP 15 cmH2O
PEEP increase
Positive End Expiratory Pressure (PEEP) will be increased from 5 to 15 cmH2O.
Interventions
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PEEP increase
Positive End Expiratory Pressure (PEEP) will be increased from 5 to 15 cmH2O.
PEEP decrease
Positive End Expiratory Pressure (PEEP) will be decreased from 15 to 5 cmH2O.
Eligibility Criteria
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Inclusion Criteria
* undergoing deep sedation
* on controlled mechanical ventilation
* between 24 hours and 5 days after intubation.
Exclusion Criteria
* patient undergoing legal protection
* contra-indications to EIT (e. g. severe chest trauma or wounds)
* pneumothorax; patient undergoing ECMO
* patient with BMI ≥35 kg/m2
* hemodynamic instability with MAP \<60 mmHg despite vasopressors.
18 Years
ALL
No
Sponsors
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University Hospital, Angers
OTHER_GOV
Responsible Party
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Locations
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Angers Hospital
Angers, Maine et Loire, France
Countries
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Central Contacts
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Facility Contacts
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Other Identifiers
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2022-A00649-34
Identifier Type: -
Identifier Source: org_study_id
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