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Personalized Mechanical Ventilation Guided by UltraSound in Patients With Acute Respiratory Distress Syndrome
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Summary
Rationale Acute respiratory distress syndrome (ARDS) is a frequent cause of hypoxemic respiratory failure with a mortality rate of approximately 30%. The identification of ARDS phenotypes, based on focal or non-focal lung morphology, can be helpful to better target mechanical ventilation strategies of individual patients. Lung ultrasound (LUS) is a non-invasive tool that can accurately distinguish 'focal' from 'non-focal' lung morphology. The investigators hypothesize that LUS-guided personalized mechanical ventilation in ARDS patients will lead to a reduction in 90-day mortality compared to conventional mechanical ventilation.
Key Details
Gender
All
Age Range
18 Years - 100 Years
Study Type
INTERVENTIONAL
Enrollment
538
Start Date
2022-08-09
Completion Date
2027-11-01
Last Updated
2025-12-08
Healthy Volunteers
No
Interventions
Personalized ventilation
Patients who are randomized for personalized ventilation with FOCAL ARDS will receive the following ventilator settings: * Positive end-expiratory pressure (PEEP) ≤ 9 cm water (H2O) * Tidal volume: 6 to 8 mL/kg predicted body weight (PBW) * Daily prone positioning LUS will be repeated every 48-72 hours in supine position for the focal ARDS patients to assess whether they have developed non-focal ARDS during admission. In that case, patients will from then on be treated according non-focal personalized treatment protocol. Patients who are randomized for personalized ventilation with Non-FOCAL ARDS will receive the following ventilator settings: * PEEP ≥ 15 cm H2O * Tidal volume: 4 to 6 mL/kg PBW * Daily recruitment maneuver
Standard care
Patient who are randomized in the control group will receive standard care * Tidal volume: 6 mL/kg PBW * PEEP and FiO2 according to the low PEEP and high fraction of inspired oxygen (FiO2) table of the AlVEOLI study * Prone positioning if the Partial Pressure of Oxygen (PaO2) /FiO2 ratio is \< 150 mmHg
Locations (10)
Chu-Brugmann
Brussels, Belgium
Bispebjerg Hospital
Copenhagen, Denmark
Nordsjaellands Hospital
Hillerød, Denmark
Evaggelismos Hospital
Athens, Greece
Galway University Hospitals
Galway, Ireland
Ospedale Generale Regionale F. Miulli
Acquaviva delle Fonti, Bari, Italy
Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari
Bari, Italy
Amsterdam UMC, location VUmc
Amsterdam, North Holland, Netherlands
Amsterdam UMC, location AMC
Amsterdam, North Holland, Netherlands
Centralny Szpital Kliniczny MSWiA
Warsaw, Poland