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ARDS, HumanTGV-MOANCT06119516

Transpulmonary Pressure - Guided Mechanical Ventilation in Morbidly Obese ARDS Patients: a Feasibility Study.

A study testing Esophageal pressure-guided strategy, in people with ARDS, Human and Obesity, Morbid, run by Assistance Publique - Hôpitaux de Paris at 5 sites in France.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to test a personalized intervention aiming to optimize the mechanical ventilator settings in morbidly obese patients suffering from moderate to severe Acute Respiratory Distress Syndrome (ARDS). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
ARDS, Human, Obesity, Morbid
What is being tested?
Esophageal pressure-guided strategy,
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
5 sitesFrance
Study dates
4 Apr 2024to 4 Jul 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult patient (aged 18 years or older)
  • Class III morbid obesity (BMI > 40 kg/m2)
  • Moderate or severe ARDS criteria (according to the Berlin definition)
  • Less than 72 hours between fulfilling moderate or severe ARDS criteria and inclusion
  • Tracheal intubation and invasive mechanical ventilation
  • Informed consent (patient, next of kin), with possibility of an emergency procedure with deferred consent
  • Covid-19 and non-Covid-19 patients

Who cannot join

  • Contra-indication to nasogastric tube (uncontrolled coagulopathy, severe thrombocytopenia, nasal trauma, esophageal varices)
  • Order to limit life-sustaining therapy
  • ExtraCorporal Membrane Oxygenation (ECMO) in use
  • Invasive mechanical ventilation > 96 hours
  • Elevated intracranial pressure
  • Active air-leak: pneumothorax, pneumomediastinum
  • Pregnancy or breast feeding
  • Patient on state medical aid

Trial locations and contacts

5 sites in 1 country. Contact the study team or a site near you to ask about taking part.

5 sites in 1 country

France5 sites, 5 recruiting
  • CHU Angers

    Angers, 49933

    Alain MD Mercat, PhD, 02 41 35 38 15, AlMercat@chu-angers.fr

    Recruiting
  • Hôpital Bicêtre, AP-HP

    Le Kremlin-Bicêtre, 94270

    Tài Olivier MD Pham, PhD, 01 45 21 35 44, tai.pham@aphp.fr

    Recruiting
  • Hôpital de la Croix-Rousse, HCL

    Lyon, 69004

    Jean-Christophe MD Richard, PhD, 04 26 10 92 72, j-christophe.richard@chu-lyon.fr

    Recruiting
  • AP-HP, Hôpital Européen Georges Pompidou

    Paris, 75015

    Jean-Luc MD Diehl, PhD, 01 56 09 32 13, jean-luc.diehl@aphp.fr

    Recruiting
  • CHU la Milétrie

    Poitiers, 86021

    Rémi MD Coudroy, PhD, 05 49 44 43 67, remi.coudroy@chu-poitiers.fr

    Recruiting

Other trials in France

About this study

The goal of this clinical trial is to test a personalized intervention aiming to optimize the mechanical ventilator settings in morbidly obese patients suffering from moderate to severe Acute Respiratory Distress Syndrome (ARDS). The intervention consists of personalized measurements and calculations of the different pressures inside the thorax. The main question to answer is:

  • Will the evaluated esophageal pressure-guided strategy lead to different mechanical ventilator settings than suggested by a strategy largely used in ARDS patients in France?
Read more

A specific nasogastric probe permitting to measure esophageal pressure will monitor participants. Esophageal pressure will act as an indicator of the pleural pressure. Other respiratory signals displayed by the mechanical ventilators will also be acquired.

Further, ventilator settings will be adjusted to the evaluated esophageal pressure-guided strategy, with possible benefit of this personalized approach.

Read the detailed description

The goal of this clinical trial is to test a personalized intervention aiming to optimize the mechanical ventilator settings in morbidly obese patients suffering from moderate to severe Acute Respiratory Distress Syndrome (ARDS). Mechanical ventilation is the cornerstone of the ARDS symptomatic treatment. Individualization of mechanical ventilator settings could improve prognosis mainly by preventing or decreasing accumulation of fluid in the lung and hemodynamic impairment. It is likely that class III obesity ARDS patients (defined by body mass index (BMI) > 40 kg/m2), could benefit from a highly personalized approach, based on esophageal pressure monitoring. These patients have significantly higher esophageal pressures, acting as an indicator of pleural pressure, than the general ARDS population, while these patients have rather normal mechanical characteristics of the chest wall. Such features could suggest innovative mechanical ventilator settings, by integrating esophageal pressures values, aiming to obtain a slightly positive transpulmonary pressure at the end of expiration.

The intervention consists of personalized measurements and calculations of the different pressures, including the esophageal one, inside the thorax.

The main question to answer is:

  • Will the evaluated esophageal pressure-guided strategy lead to different mechanical ventilator settings, mainly the positive end-expiratory pressure (PEEP) setting, than suggested by a PEEP-strategy largely used in ARDS patients in France?

A specific nasogastric probe permitting to measure esophageal pressure will monitor participants. The second generation esogastric multifunction Nutrivent catheter (SIDAM, Mirandola, Italy) will be used. It allows both enteral nutrition of the patients and monitoring of esophageal and gastric pressures during several days. Esophageal pressure will act as an indicator of the pleural pressure. Other respiratory signals displayed by the mechanical ventilators will also be acquired, permitting to calculate the trans-pulmonary pressures.

Further, ventilator settings will be adjusted to the evaluated esophageal pressure-guided strategy, with possible benefits of this personalized approach. The main benefits for the research participants will be the application of highly personalized mechanical ventilator settings, aiming mainly to select the best PEEP setting with the goal of optimization of opening the lung while avoiding the respiratory and hemodynamic consequences of excessive lung inflation. Monitoring of the end-inspiratory transpulmonary pressures will help to prevent excessive lung inflation.

Being tested
Esophageal pressure-guided strategy,
Keywords
ARDS, Human, Obesity, morbid, Mechanical Ventilation, Transpulmonary pressure
Medical subject headings
Respiratory Distress Syndrome, Obesity, Morbid

What participants receive

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

  • Esophageal pressure-guided strategy,Other

    A catheter-balloon system will be positioned and calibrated in all included patients. The second generation esogastric multifunction Nutrivent catheter (SIDAM, Mirandola, Italy) will be used. It allows both enteral nutrition of the patients and monitoring of esophageal and gastric pressures during several days. A connection line will be inserted between the catheter (either esophageal or gastric balloon port) and the auxiliary pressure port of the mechanical ventilator (General Electric, R860, available in each center). Numeric recording of the respiratory signals will be achieved via the OhmedaCom Research Tool software, helping for centralization of the analyses, therefore ensuring reproducibility of the results.

Study groups in NCT06119516
Study groupRoleWhat they receive
Esophageal pressure-guided strategy,ExperimentalThe second generation esogastric multifunction Nutrivent catheter (SIDAM, Mirandola, Italy) will be used to monitor esophageal and gastric pressures during several days. Ventilator settings will be adjusted to the evaluated esophageal pressure-guided strategy, aiming to obtain a slightly positive transpulmonary pressure at the end of expiration.
Receives: Other: Esophageal pressure-guided strategy,

What is being measured

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

  1. The absolute value of the difference between the PEEP levels determined by esophageal pressure-guided strategy and by the PEEP level indicated by the maximal recruitment arm of the ExPress trial

    To demonstrate that the evaluated esophageal pressure-guided strategy leads to significantly and clinically different mechanical ventilator settings (mainly PEEP setting) than the reference strategy.

    Measured: during the first 24 hours after inclusion

Secondary outcomes (6)
  1. The ratio between the arterial partial pressure of oxygen (PaO2) on the inspired fraction of oxygenFiO2): PaO2/FiO2 ratio

    To assess the efficacy of the esophageal pressure-guided strategy.

    Measured: during the intervention

  2. The mortality rate of included patients.

    To assess the efficacy and safety of the esophageal pressure-guided strategy.

    Measured: Mortality rate will be determined at end of ICU stay, at Day 28 and at Day 90.

  3. Number of days alive and free for invasive mechanical ventilation

    To assess the efficacy of the esophageal pressure-guided strategy.

    Measured: The numbers of days alive and free for invasive mechanical ventilationwill be determined at Day-28 and Day-90

  4. Occurrence of pneumothorax

    To assess the safety of the esophageal pressure-guided strategy.

    Measured: during the intervention

  5. Occurence of severe hemodynamic compromise defined by the need of vasoactive treatment

    To assess the safety of the esophageal pressure-guided strategy.

    Measured: during the intervention

  6. Percentage of included patients with inability to insert the Nutrivent catheter

    To assess the feasibility of the esophageal pressure-guided strategy.

    Measured: during the first 24 hours after inclusion

Timeline

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

  1. First posted7 Nov 2023
  2. Study start4 Apr 2024
  3. Primary completion4 Apr 2027 (estimated)
  4. Study completion4 Jul 2027 (estimated)

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
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06119516
Sponsor's protocol ID
APHP220824
Other IDs
2023-A01044-41, PHRC21-0254, DR-2023-130
Acronym
TGV-MOA
Status last verified
Apr 2026
First submitted
12 Oct 2023
Last updated
21 Apr 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Individual participant data (IPD) that underlie results in publication could be shared. IPD detailed in the protocol of a planned metaanalysis could be shared

Publications

  • Diehl JL, Talmor D. When could airway plateau pressure above 30 cmH2O be acceptable in ARDS patients? Intensive Care Med. 2021 Sep;47(9):1028-1031. doi: 10.1007/s00134-021-06472-5. Epub 2021 Jul 8. No abstract available.

    PubMed 34236478
  • Coudroy R, Vimpere D, Aissaoui N, Younan R, Bailleul C, Couteau-Chardon A, Lancelot A, Guerot E, Chen L, Brochard L, Diehl JL. Prevalence of Complete Airway Closure According to Body Mass Index in Acute Respiratory Distress Syndrome. Anesthesiology. 2020 Oct 1;133(4):867-878. doi: 10.1097/ALN.0000000000003444.

    PubMed 32701573
  • Florio G, Ferrari M, Bittner EA, De Santis Santiago R, Pirrone M, Fumagalli J, Teggia Droghi M, Mietto C, Pinciroli R, Berg S, Bagchi A, Shelton K, Kuo A, Lai Y, Sonny A, Lai P, Hibbert K, Kwo J, Pino RM, Wiener-Kronish J, Amato MBP, Arora P, Kacmarek RM, Berra L; investigators of the lung rescue team. A lung rescue team improves survival in obesity with acute respiratory distress syndrome. Crit Care. 2020 Jan 15;24(1):4. doi: 10.1186/s13054-019-2709-x.

    PubMed 31937345
  • Rowley DD, Arrington SR, Enfield KB, Lamb KD, Kadl A, Davis JP, Theodore DJ. Transpulmonary Pressure-Guided Lung-Protective Ventilation Improves Pulmonary Mechanics and Oxygenation Among Obese Subjects on Mechanical Ventilation. Respir Care. 2021 Jul;66(7):1049-1058. doi: 10.4187/respcare.08686. Epub 2021 Apr 20.

    PubMed 33879565
  • Sarge T, Baedorf-Kassis E, Banner-Goodspeed V, Novack V, Loring SH, Gong MN, Cook D, Talmor D, Beitler JR; EPVent-2 Study Group. Effect of Esophageal Pressure-guided Positive End-Expiratory Pressure on Survival from Acute Respiratory Distress Syndrome: A Risk-based and Mechanistic Reanalysis of the EPVent-2 Trial. Am J Respir Crit Care Med. 2021 Nov 15;204(10):1153-1163. doi: 10.1164/rccm.202009-3539OC.

    PubMed 34464237

Questions about this trial

What is this clinical trial studying?

A study testing Esophageal pressure-guided strategy, in people with ARDS, Human and Obesity, Morbid, run by Assistance Publique - Hôpitaux de Paris at 5 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 7 inclusion and 8 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: looking for participants now, as of the sponsor's last update on 21 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Joséphine Braun (01 44 84 17 38, josephine.braun@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The absolute value of the difference between the PEEP levels determined by esophageal pressure-guided strategy and by the PEEP level indicated by the maximal recruitment arm of the ExPress trial (time frame: during the first 24 hours after inclusion). 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 NCT06119516, which also lists 5 linked publications.

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 21 Apr 2026.

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