ARDS Esophageal Balloon Pressure Changes With Positioning Study
| Status: | Recruiting |
|---|---|
| Conditions: | Pulmonary |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 12/9/2018 |
| Start Date: | May 11, 2017 |
| End Date: | December 20, 2020 |
| Contact: | Arun Kannappan, MD |
| Email: | arun.kannappan@unchealth.unc.edu |
| Phone: | 2817017946 |
Assessing Pleural Pressure Changes Between Supine, Upright and Prone Mechanical Ventilation
The use of esophageal balloon catheters, which use esophageal pressure as a surrogate
measurement for transpleural pressure, shows promise in improving outcomes of patients with
severe acute respiratory distress syndrome (ARDS) requiring mechanical ventilator. The
investigators hope to measure changes in in transpleural pressures in patients undergoing
treatment with mechanical ventilation while switching from the supine, upright (head of bed
>30 degrees), and prone positions. The goal will be to measure the changes in chest wall and
lung compliance in mechanically ventilated patients with changes in position.
measurement for transpleural pressure, shows promise in improving outcomes of patients with
severe acute respiratory distress syndrome (ARDS) requiring mechanical ventilator. The
investigators hope to measure changes in in transpleural pressures in patients undergoing
treatment with mechanical ventilation while switching from the supine, upright (head of bed
>30 degrees), and prone positions. The goal will be to measure the changes in chest wall and
lung compliance in mechanically ventilated patients with changes in position.
The use of esophageal balloon catheters shows promise in improving outcomes of patients with
severe ARDS. The estimation of pleural pressure (Ppl) has been validated in the upright
position in humans with few studies commenting on the changes in supine positioning and
almost none on prone positioning aside from radiographic analysis. An abstract presented at
the annual American Thoracic Society meeting recently reported a series of 18 patients
undergoing spinal surgery. In this population of patients without ARDS, esophageal pressure
(Pes) decreased when shifting from supine to prone positioning. This suggests that
transpleural pressure (PtmL) would be increased at a given airway pressure.
The investigators hope to measure changes in PtmL in patients undergoing treatment with
mechanical ventilation while switching from the supine, upright (head of bed >30 degrees),
and prone positions. The esophageal balloon catheter will be placed using standard techniques
and secured with tape to the patients' nares during changes in positioning. The goal will be
to measure the changes in chest wall and lung compliance in mechanically ventilated patients
with changes in position.
severe ARDS. The estimation of pleural pressure (Ppl) has been validated in the upright
position in humans with few studies commenting on the changes in supine positioning and
almost none on prone positioning aside from radiographic analysis. An abstract presented at
the annual American Thoracic Society meeting recently reported a series of 18 patients
undergoing spinal surgery. In this population of patients without ARDS, esophageal pressure
(Pes) decreased when shifting from supine to prone positioning. This suggests that
transpleural pressure (PtmL) would be increased at a given airway pressure.
The investigators hope to measure changes in PtmL in patients undergoing treatment with
mechanical ventilation while switching from the supine, upright (head of bed >30 degrees),
and prone positions. The esophageal balloon catheter will be placed using standard techniques
and secured with tape to the patients' nares during changes in positioning. The goal will be
to measure the changes in chest wall and lung compliance in mechanically ventilated patients
with changes in position.
Inclusion Criteria:
- age at least 18 years old, need for mechanical ventilation, moderate or severe ARDS,
and the ability to tolerate prone positioning.
Exclusion Criteria will be patients who:
- are deemed too ill by their clinicians to be included in the study
- have esophageal or nasopharyngeal pathology (such as tumors, sinusitis, epistaxis,
ulcerations, recent surgery or bleeding varices) preventing insertion of the
esophageal balloon catheter
- diverticulitis
- bronchopulmonary fistula
- solid-organ transplantation
- history of difficult intubation or airway management
- or contraindications to prone positioning (per the UNC Medical Intensive Care Unit
Pronation Therapy protocol, attached)
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