Optimization of Positive End Expiratory Pressure by Use of Pulmonary Ultrasound for Patients With Blunt Chest Trauma Treated by Non-Invasive Ventilation (Opti-PEP).

Launched by UNIVERSITY HOSPITAL, MONTPELLIER · Oct 2, 2023

Keywords

ClinConnect Summary

The Opti-PEP trial is a research study aimed at improving the treatment of patients with blunt chest injuries who are having trouble breathing. Specifically, it is comparing two different ways of starting non-invasive ventilation, which is a method to help patients breathe without needing a breathing tube. In one group, physiotherapists will use a special ultrasound tool to help find the best settings for a treatment called Positive End Expiratory Pressure (PEEP) during the first session. The other group will receive standard care without the ultrasound assistance.

To participate in this trial, patients need to be at least 18 years old and admitted to the hospital with specific types of chest injuries like broken ribs or lung bruising. They should also be experiencing difficulty breathing that requires oxygen support. However, patients with severe breathing issues, those who need invasive ventilation, or certain other medical conditions cannot join. If eligible, participants will receive either the ultrasound-guided treatment or the usual care and will be monitored to see which approach works better. This study is currently looking for volunteers to help us learn more about how to improve care for patients facing these challenges.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients aged 18 or more
• • Admitted to intensive care or continuing care for 72 hours or less for blunt chest trauma, defined by the presence of at least one of the following elements on the initial CT scan: fracture(s) of rib(s) / fracture(s) of the sternum / pulmonary contusion / hemothorax
• • Acute hypoxemic respiratory failure defined by the administration of oxygen at least 3 L/min with nasal cannula or FiO2≥30% if high flow oxygen therapy.
• • Patient with a functional arterial catheter for blood tests
• Exclusion Criteria:
• • Acute respiratory distress, defined by the presence of at least one of the following clinical signs: respiratory rate ˃ 35 / use of accessory inspirators / paradoxal abdominal or thoracic motion
• • Imminent need for invasive mechanical ventilation
• • Usual contraindication to non-invasive ventilation (undrained pneumothorax, trauma to the face, vigilance disorders, digestive bleeding, hemodynamic instability, intolerance)
• • Hypercapnia (PaCO2˃45mmHg)
• • Patient unable to cooperate, communicate
• • Therapeutic limitation
• • Expected length of stay ≤ 48h
• • Severe head trauma
• • Pregnant or breastfeeding women
• • Participation in other clinical research related to respiratory failure/respiratory therapy
• • Vulnerable people
• • Protected adults, under guardianship or curatorship, or unable to give consent
• • Non-affiliated person or beneficiary of a social security scheme
• • Absence of free, informed and written consent, signed by the participant and the investigator