The Impact of Low Versus High Positive End-expiratory Pressure on Diaphragm Function, Ventilation Efficiency, and Lung Mechanics

NCT ID: NCT07188038

Last Updated: 2025-09-23

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

25 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-01

Study Completion Date

2027-12-31

Brief Summary

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The goal of this interventional study is to evaluate the effect of different positive end-expiratory pressures (PEEP) on lung and diaphragm function in patients mechanically ventilated with pressure support ventilation in the intensive care unit. The main questions aim to answer:

Does higher PEEP level affect diaphragm contractions and ventilatory efficiency? Does higher PEEP level limit inspiratory efforts? Does higher PEEP level affect lung compliance?

The participants will be subjected to three different PEEP levels during pressure support ventilation:

Low PEEP (4 cmH2O), Medium PEEP (10 cmH2O), High PEEP (16 cmH2O).

The lung and diaphragm function will be evaluated using high-resolution esophageal manometry, electrical activity of the diaphragm, external diaphragm ultrasound and spirometric ventilator data.

Detailed Description

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Conditions

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Respiratory Failure ARDS (Acute Respiratory Distress Syndrome) Pneumonia Respiratory Insufficiency

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Randomized interventional crossover study
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants

Study Groups

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Low PEEP

Low positive end-expiratory pressure (4 cmH2O)

Group Type EXPERIMENTAL

Low positive end-expiratory pressure

Intervention Type PROCEDURE

Low (4 cmH2O) positive end-expiratory pressure (PEEP) will be applied during pressure support ventilation. The PEEP level will be kept for 10 minutes prior to data acquisition.

Medium PEEP

Medium positive end-expiratory pressure (10 cmH2O)

Group Type EXPERIMENTAL

Medium positive end-expiratory pressure

Intervention Type PROCEDURE

Medium (10 cmH2O) positive end-expiratory pressure (PEEP) will be applied during pressure support ventilation. The PEEP level will be kept for 10 minutes prior to data acquisition.

High PEEP

High positive end-expiratory pressure (16 cmH2O)

Group Type EXPERIMENTAL

High positive end-expiratory pressure

Intervention Type PROCEDURE

High(16 cmH2O) positive end-expiratory pressure (PEEP) will be applied during pressure support ventilation. The PEEP level will be kept for 10 minutes prior to data acquisition.

Interventions

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Low positive end-expiratory pressure

Low (4 cmH2O) positive end-expiratory pressure (PEEP) will be applied during pressure support ventilation. The PEEP level will be kept for 10 minutes prior to data acquisition.

Intervention Type PROCEDURE

Medium positive end-expiratory pressure

Medium (10 cmH2O) positive end-expiratory pressure (PEEP) will be applied during pressure support ventilation. The PEEP level will be kept for 10 minutes prior to data acquisition.

Intervention Type PROCEDURE

High positive end-expiratory pressure

High(16 cmH2O) positive end-expiratory pressure (PEEP) will be applied during pressure support ventilation. The PEEP level will be kept for 10 minutes prior to data acquisition.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Mechanical ventilation with pressure support or mechanical ventilation with possibility to transition to pressure support
* Oxygen requirement ≤ 50%
* Pressure support ≤ 12 cmH2O
* PEEP ≤ 12 cmH2O
* Age ≥ 18 years
* Adequate intravascular volume status

Exclusion Criteria

* Circulatory instability
* Brain death diagnosis/brain death evaluation
* Norepinephrine dose \> 0.4 µg/kg/min
* Muscle relaxation administered within 2 hours
* Pregnancy
* Contraindication to esophageal catheterization (e.g., esophageal varices)
* Conditions with increased risk of pneumothorax (such as severe COPD (Chronic Obstructive Pulmonary Disease) or extensive emphysema)
* Untreated pneumothorax
* Symptomatic airway obstruction

Discontinuation criteria during ongoing study intervention:

* Heart rate \> 120 beats/min
* Systolic blood pressure \> 180 mmHg
* Inspired oxygen fraction \> 70%
* Respiratory rate \> 35/min
* RASS (Richmond Agitation Sedation Scale) ≥ 2
* Doubling of norepinephrine dose or increase of norepinephrine dose to \> 0.5 µg/kg/min to maintain mean arterial pressure
* Bradycardia \< 45 beats/min
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sahlgrenska University Hospital

OTHER

Sponsor Role collaborator

Göteborg University

OTHER

Sponsor Role collaborator

Vastra Gotaland Region

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hannes Widing

Role: PRINCIPAL_INVESTIGATOR

Anesthesia and intensive care medicine, Område 5, Sahlgrenska University hospital, Västra Götalandsregionen

Locations

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Central intensivvårdsavdelning, Sahlgrenska University Hospital

Gothenburg, Västra Götaland County, Sweden

Site Status

Thorax intensivvårdsavdelning, Område 6, Sahlgrenska University Hospital, Västra Götalandsregionen

Gothenburg, Västra Götaland County, Sweden

Site Status

Countries

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Sweden

Central Contacts

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Hannes Widing

Role: CONTACT

0046703957374

Per Persson

Role: CONTACT

Facility Contacts

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Hannes Widing

Role: primary

0046703957374

Viktor Erbring

Role: primary

0046706456664

Other Identifiers

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2025-01286-01

Identifier Type: -

Identifier Source: org_study_id

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