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Acute Respiratory Distress SyndromeVD-SDRANCT04184674

Impact of the Transpulmonary Pressure on Right Ventricle Function in Acute Respiratory Distress Syndrome

A study testing Pneumotachograph, Esophageal catheter and Transthoracic and / or transesophageal cardiac ultrasound in people with Acute Respiratory Distress Syndrome, run by Assistance Publique - Hôpitaux de Paris at 2 sites in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Pulmonary distension induced by mechanical ventilation physiologically alters right ventricle pre and after-load, hence might lead to right ventricle failure. The hypothesis is that in Acute Respiratory Distress Syndrome, the occurence of a right ventricle failure under lung protective ventilation might : i) be… Read more about this study

Who is it for?
Ages 1 month and older
Conditions the study is for
Acute Respiratory Distress Syndrome
What is being tested?
Pneumotachograph, Esophageal catheter and Transthoracic and / or transesophageal cardiac ultrasound
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
2 sitesFrance
Study dates
11 Jun 2020to 11 Jun 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 month and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Patients over one month
  • Patients with mild to severe ARDS (onset within 48 hours). ARDS definition will follow Berlin guidelines for adults, and Pediatric Acute Lung Injury Consensus Conference (PALICC) guidelines for children
  • Signed consent

Who cannot join

  • Neonates less than 28 days-old
  • Pregnancy or breastfeeding
  • Any contra-indication to esophageal manometry (less than one month esophagus surgery, bronchopleural or esotracheal fistula, latex allergy)
  • No social care

Trial locations and contacts

2 sites in 1 country.

France2 sites
  • Hôpital Ambroise Paré

    Boulogne-Billancourt, 92100

  • Hôpital Necker-Enfants Malades

    Paris, 75015

Other trials in France

About this study

Pulmonary distension induced by mechanical ventilation physiologically alters right ventricle pre and after-load, hence might lead to right ventricle failure. The hypothesis is that in Acute Respiratory Distress Syndrome, the occurence of a right ventricle failure under lung protective ventilation might :

  1. be correlated to the transpulmonary pressure level, ii) lead to global heart failure, iii) and extremely result in poor outcome and death.
Read more

The primary objective is to test the impact of transpulmonary pressure on right ventricular function in Acute Respiratory Distress Syndrome in adults and children.

Secondary objectives are :

  1. to compare thresholds of transpulmonary pressure associated with right ventricle failure between children and adults. ii) to assess if there is an association between transpulmonary pressure and morbidity and mortality.
  • For pediatric patients, a specific monitoring with electrical impedance tomography (EIT) will allow:
  • To assess if the transpulmonary pressure is associated with the level of regional pulmonary overdistention (or collapse) on electrical impedance tomography.(EIT)
  • To assess if there is an association between the occurrence of right ventricular failure, and distribution of ventilation on EIT.
Read the detailed description

Acute Respiratory Distress Syndrome (ARDS) is an acute inflammatory lung injury associated with a high pulmonary vascular permeability, leading to acute respiratory failure. Positive pressure mechanical ventilation,improves survival but might lead to ventilator-induced lung injury (VILI) and right ventricular failure. This hemodynamic effect is more important when compliance is decreased, especially in ARDS.

The use of long protective ventilation (with low tidal volumes and low plateau pressures) has improved prognosis of ARDS in adult patients. However, tidal volume and plateau pressures do not always reflect the lung deformation and the stress induced by the ventilation; these variables depend on the characteristics of the patient's respiratory system. Therefore, management focuses on ventilation strategies according to these characteristics.

Among tools used to evaluate respiratory physiological parameters, the esophageal pressure measurement is easily feasible at the bedside, and well estimates pleural pressure and pulmonary distension. During invasive ventilation, transpulmonary pressure (PL) can be obtained with the difference between the airway pressure and the esophageal pressure. Calculation of transpulmonary pressure in ARDS allows optimal ventilator management of adult and children treated for ARDS.

Although individualized ventilation techniques have shown some benefits in ARDS, studies have failed to show that survival could be improved by such strategies. This lack of efficacy could be partly explained by the hemodynamic impact of ventilation-induced pulmonary distension. It therefore seems essential to combine a robust assessment of right ventricular function with measurements of transpulmonary pressure in order to know the real hemodynamic impact of positive pressure ventilation in ARDS in adults and children.

The primary objective is to test the impact of transpulmonary pressure on right ventricular functionin ARDS adults and children.

Secondary objectives are :

  1. to compare thresholds of transpulmonary pressure associated to right ventricle failure between children and adults ii) to assess if there is an association between transpulmonary pressure and morbidity and mortality.
  • For pediatric patients, a specific monitoring with electrical impedance tomography (EIT) will allow:
  • To assess if the transpulmonary pressure is associated with the level of regional pulmonary overdistention (or collapse) on electrical impedance tomography.(EIT)
  • To assess if there is an association between the occurrence of right ventricular failure, and distribution of ventilation on EIT.
Being tested
Pneumotachograph, Esophageal catheter, Transthoracic and / or transesophageal cardiac ultrasound, Electrical impedance tomography (EIT) for pediatric patients
Keywords
Acute Respiratory Distress Syndrome, Mechanical ventilation, Transpulmonary pressure, Right ventricle failure
Medical subject headings
Respiratory Distress Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PneumotachographOther

    Measurements will be performed during the first three days of Acute Respiratory Distress Syndrome management :

    • The first measurement will be performed 5 minutes after the initial ventilator settings.
    • Measurements will be repeated systematically at 24 hours, 48 hours and 72 hours of evolution.
    • An additional measure will be performed at each positive end-expiratory pressure modification (maximum 5 measures).
  • Esophageal catheterOther

    Measurements will be performed during the first three days of Acute Respiratory Distress Syndrome management

    • The first measurement will be performed 5 minutes after the initial ventilator settings.
    • Measurements will be repeated systematically at 24 hours, 48 hours and 72 hours of evolution.
    • An additional measure will be performed at each positive end-expiratory pressure modification (maximum 5 measures).
  • Transthoracic and / or transesophageal cardiac ultrasoundOther

    The right ventricle systolic function will be assessed thanks to a transthoracic cardiac ultrasound in children, and a transthoracic of a transesophageal cardiac ultrasound in adults :

    Measurements will be performed during the first three days of Acute Respiratory Distress Syndrome management :

    • The first measurement will be performed 5 minutes after the initial ventilator settings.
    • Measurements will be repeated systematically at 24 hours, 48 hours and 72 hours of evolution.
    • An additional measure will be performed at each positive end-expiratory pressure modification (maximum 5 measures).
  • Electrical impedance tomography (EIT) for pediatric patientsOther

    For pediatric patients: measurements will be performed during the first three days of Acute Respiratory Distress Syndrome management.

Study groups in NCT04184674
Study groupRoleWhat they receive
Acute Respiratory Distress SyndromeOtherChildren of more than one month of age and adults hospitalized in Intensive Care Unit for Acute Respiratory Distress Syndrome.
Receives: Other: Pneumotachograph; Other: Esophageal catheter; Other: Transthoracic and / or transesophageal cardiac ultrasound; Other: Electrical impedance tomography (EIT) for pediatric patients

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Right ventricle failure

    Right ventricle failure is defined, by ultrasound, as a composite criteria associating :

    • end-diastolic right ventricle/left ventricle area ratio > 0.6 and/or Acute Cor Pulmonale (assocation with a septal dyskinesia),
    • and/or a tricuspid annular plane systolic excursion < 1,6 cm (adults), z-score < -2 (children),
    • and/or a doppler-derived tricuspid lateral annular systolic velocity (S wave) < 10 cm/s,
    • and/or a two-dimensional Fractional Area Change (defined as end-diastolic area - end-systolic area)/end-diastolic area x100) < 35%,
    • and/or a peak right ventricle free wall 2D strain < -30% (adults), z-score < 2 (children).

    Measured: Three days

Secondary outcomes (13)
  1. Airways pressure

    Airways pressure (Paw) will be measured in cmH2O thanks to a pneumotachograph connected to the ventilator.

    Measured: Three days

  2. Oesophageal pressure

    Esophageal pressure (Pes) will be measured in cmH2O thanks to an oesophageal balloon catheter introduced in the mid-esophagus of the patient and connected to a manometer.

    Measured: Three days

  3. Transpulmonary pressure calculation

    Measurements will be performed at different moments during the respiratory cycle: after an inspiratory pause to evaluate the tele-inspiratory transpulmonary pressure (PL-insp), and after an expiratory pause to evaluate the tele-expiratory transpulmonary pressure (PL-PEP ). The PL-insp will be calculated using the ratio between the elastance of the chest wall (Ecw) and of the respiratory system (Ers) thanks to this formula PL = Paw - Paw x (Ecw/Ers). The PL-exp will be calculated using the ratio between Paw et Pes (PL = Paw - Pes). Transpulmonary pressure will be expressed in cmH2O.

    Measured: Three days

  4. Vaso-Active Inotrope Score (VIS)

    Correlation between transpulmonary pressure and morbidity. Vaso-Active Inotrope Score is a hemodynamic score taking into account the cumulative doses of inotropic or vassopressive drugs. It is obtained thanks this calculation : VIS = dopamine dose (µg/kg/min) + dobutamine dose (µg/kg/min) + 100 x epinephrine dose (µg/kg/min) + 10 x milrinone dose (µg/kg/min) + 10000 x vasopressin dose (µg/kg/min) + 100 x norepinephrine dose (µg/kg/min). Its value ranges from zero, which is associated to a better outcome, to the maximum cumulative dose without any limit.

    Measured: Three days

  5. Duration of treatment with vasoactive or inotropic drugs

    Number of days under vaso-active or inotropic drugs

    Measured: 3 months after hospitalization in Intensive Care Unit

  6. Pediatric logistic organ dysfunction score

    Pediatric logistic organ dysfunction score is a specific pediatric multiple organ dysfunction score that includes 10 variables corresponding to 5 organ dysfunctions. Values extend from 0 (best outcome) to 33 (worst outcome).

    Measured: Three days

  7. Sepsis-related Organ Function Assessement score

    Sepsis-related Organ Function Assessement score is a multiple organ dysfunction score that includes several variables corresponding to 6 organ dysfunctions. Values extend from 0 (best outcome) to 24 (worst outcome).

    Measured: Three days

  8. Invasive and non invasive ventilation free days

    Number of invasive and non invasive ventilation free days

    Measured: 3 months after hospitalization in Intensive Care Unit

  9. Lung and Chest Wall compliance

    Lung and chest wall compliances (in mL/cmH2O) will be calculated thanks to the respective ratios tidal volume/(PL-insp - PL-PEP) and tidal volume/(Pes insp - Pes-PEP).

    Measured: Three days

  10. Length of hospitalization

    Length of hospitalization in Intensive Care Unit and in hospital in days.

    Measured: 3 months after hospitalization in Intensive Care Unit

  11. Mortality at 28 days

    Death in Intensive Care Unit and at 28 days of hospitalization.

    Measured: 28 days

  12. Mortality in Intensive Care Unit

    Death in Intensive Care Unit.

    Measured: 3 months after hospitalization in Intensive Care Unit

  13. Eletrical impedance tomography

    Electrical impedance tomography will be monitored only in children. Several methods will be used and compared, based on e.g. pixel information of lung aeration, to assess end-expiratory lung volume (ELLV, in mL) and the distribution of ventilation

    Measured: 3 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Dec 2019
  2. Study start11 Jun 2020
  3. Primary completion11 Jun 2022
  4. Study completion11 Jun 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04184674
Sponsor's protocol ID
APHP191033
Other IDs
2019-A02814-53
Acronym
VD-SDRA
Status last verified
Mar 2026
First submitted
28 Nov 2019
Last updated
11 Mar 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Vedrenne-Cloquet M, Petit M, Khirani S, Charron C, Khraiche D, Panaioli E, Habib M, Renolleau S, Fauroux B, Vieillard-Baron A. Impact of the transpulmonary pressure on right ventricle impairment incidence during acute respiratory distress syndrome: a pilot study in adults and children. Intensive Care Med Exp. 2024 Sep 27;12(1):84. doi: 10.1186/s40635-024-00671-2.

    PubMed 39331249

Questions about this trial

What is this clinical trial studying?

A study testing Pneumotachograph, Esophageal catheter and Transthoracic and / or transesophageal cardiac ultrasound in people with Acute Respiratory Distress Syndrome, run by Assistance Publique - Hôpitaux de Paris at 2 sites in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Right ventricle failure (time frame: Three days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04184674, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Mar 2026.

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