Acute Respiratory Distress Syndrome (ARDS) is defined according to the Berlin definition (1) as diffuse lung damage occurring in patients with a predisposing risk factor.
Positioning in the prone position (PP) has been shown to decrease mortality in patients with moderate to severe ARDS.
However, this technique is not without deleterious effects such as ventilator-associated pneumonia, endotracheal tube obstruction, development of pressure ulcers, and increased workload for the caregivers.
There are other positioning techniques such as the "upright" position, which simulates a relative verticality, which allows to increase the effects of the prone position and even in some patients to improve oxygenation without the PP in the acute phase of ARDS.
However, given the revolution caused by the use of PP in ARDS patients, verticalization have not been studied in more details.
Today, there is a bed on the market that allows patients to be truly upright without having to transfer them to a tilt table.
The investigators believe that raising ARDS patients in the acute phase is safe and feasible in routine practice. In this research protocol comparing PP and verticalization in a crossover trial design in acute ARDS patients, the investigators want to show that this technique can be safe and feasible, with the same effects on oxygenation as PP.
Major patient > 18 years of age
ARDS patients with PaO2/FiO2 ratio < 150 at any time within 24 hours prior to the screening visit
Hemodynamically stable patient with mean arterial pressure (MAP) > 65 mmHg maintained without vasopressor or with norepinephrine at a dosage of less than 0.5 µg/kg/min.
Patient having already undergone at least 1 but less than 5 PP sessions
Pregnant women (positive pregnancy test during screening)
Breastfeeding women
Protected Majors
Body weight greater than 198 kg (bed load limit)
Crossover
Verticalization and Prone position
Procedure/SurgeryThe randomly selected study sequence (Arm1, Arm2, Arm3 or Arm4) will begin after the supine roll-over at the end of the first PP session (out-of-study sequence). This allows all patients to initially have the positioning technique that has been proven beneficial in ARDS. The chronology of the treatment periods in each of the 4 arms allocated by randomization will be as follows: Each PP must be started within 4 to 8 hours after the end of the previous PP or after the end of the verticalization that just preceded it. Each verticalization must be performed within 4 to 8 hours after the end of the previous PP or the previous verticalization. Each PP period will last between 12 and 20 hours.
Percentage of patients who were able to reach 55° of verticalization without serious adverse events (with a complete listing of all adverse events).
To demonstrate the feasibility and safety in routine practice of the verticalization technique for patients with moderate to severe ARDS in the acute phase.
PaO2/FiO2 ratio at one hour from the end of the maneuver
To show that verticalization of ARDS patients has the same effects on oxygenation (PaO2/FiO2 ratio) as PP. In this crossover trial, each sequence of four treatment periods, beginning at time of randomization, will last a maximum of 75,5 hours for each patient. The last assessment will occur at a maximum of 76,5 hours from randomisation.
Quasi-static compliance in (ml/cmH2O) before, at the end and one hour after each positioning technique
To evaluate the impact of the positioning maneuver on quasi-static thoracopulmonary compliance. In this crossover trial, each sequence of four treatment periods, beginning at time of randomization, will last a maximum of 75,5 hours for each patient. The last assessment will occur at a maximum of 76,5 hours from randomisation.
Lung Reaeration Score at 1 hour from the end of the maneuver
To compare the re-ventilation of the pulmonary territories at one hour of the session (PP or verticalization) evaluated by thoracic ultrasound. In this crossover trial, each sequence of four treatment periods, beginning at time of randomization, will last a maximum of 75,5 hours for each patient. The last assessment will occur at a maximum of 76,5 hours from randomisation.
Click on the lead sponsor to view all of their trials.
