Open Lung Strategy in Critically Ill Morbid Obese Patients
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Obesity Weight Loss, Cardiology, Cardiology, Hospital, Pulmonary |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology, Pulmonary / Respiratory Diseases, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/13/2019 |
| Start Date: | April 2016 |
| End Date: | June 30, 2020 |
Open Lung Strategy in Critically Ill Morbid Obese Patients Lung Imaging and Heart-lung Interaction
The goal of this interventional crossover study in morbidly obese intubated and mechanically
ventilated patients is to describe the respiratory mechanics and the heart-lung interaction
at titrated positive end-expiratory pressure levels following a recruitment maneuver with
transthoracic echocardiography and electric impedance tomography imaging.
ventilated patients is to describe the respiratory mechanics and the heart-lung interaction
at titrated positive end-expiratory pressure levels following a recruitment maneuver with
transthoracic echocardiography and electric impedance tomography imaging.
Obese patients under mechanical ventilation are more likely to develop atelectasis as a
consequence of the increased abdominal weight. Atelectasis is the primary responsible for
respiratory insufficiency and impossibility to wean obese patients from respiratory support.
In a previous study we demonstrated the efficacy of the application of titrated PEEP levels
following a recruitment maneuver in obese patients, i.e. improvement in respiratory mechanics
and gas exchanges without negative hemodynamic effects.
The application of lung and heat imaging will allow us to quantitatively describe:
- Increase in aerated lung tissue (reduction of atelectasis)
- Reduction of over-inflation of the ventilated regions
- Recoupling of ventilation and perfusion
- Improvement in right heart function by reduction of right heart afterload
consequence of the increased abdominal weight. Atelectasis is the primary responsible for
respiratory insufficiency and impossibility to wean obese patients from respiratory support.
In a previous study we demonstrated the efficacy of the application of titrated PEEP levels
following a recruitment maneuver in obese patients, i.e. improvement in respiratory mechanics
and gas exchanges without negative hemodynamic effects.
The application of lung and heat imaging will allow us to quantitatively describe:
- Increase in aerated lung tissue (reduction of atelectasis)
- Reduction of over-inflation of the ventilated regions
- Recoupling of ventilation and perfusion
- Improvement in right heart function by reduction of right heart afterload
Inclusion Criteria:
- ICU admitted requiring intubation and mechanical ventilation
- BMI ≥ 35 kg/m2
- Waist circumference > 88 cm (for women)
- Waist circumference > 102 cm (for men)
Exclusion Criteria:
- Known presence of esophageal varices
- Recent esophageal trauma or surgery
- Severe thrombocytopenia (Platelets count ≤ 5,000/mm3)
- Severe coagulopathy (INR ≥ 4)
- Presence or history of pneumothorax
- Pregnancy
- Patients with poor oxygenation index (PaO2/FiO2< 100 mmHg with at least 10 cmH2O of
PEEP)
- Pacemaker and/or internal cardiac defibrillator
- Hemodynamic parameters: systolic blood pressure (SBP) <100 mmHg and >180 mmHg, or if
SBP is between 100-180 mmHg on high dose of IV continuous infusion norepinephrine (>20
μg per minute), or dobutamine (>10 μg per minute), or dopamine (>10 μg per Kg per
minute), or epinephrine (>10 μg per minute).
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