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NCT Number: NCT07623590

Titration of Positive End-expiratory Pressure: Comparison Between Manual Thoracic or Abdominal Compression and Electrical Impedance Tomography

Patients with acute respiratory distress syndrome are placed on mechanical ventilation, and the adjustment of ventilator parameters is an important step in their care, in particular positive expiratory pressure, applied at the end of breathing.

The goal of this study is to learn if continuous anterior chest compression works as well as electrical impedance tomography for positive expiratory pressure titration.

Researchers will compare the two methods for each patient, in a randomly determined order : continuous anterior chest compression and electrical impedance tomography.

Participants will :

* have a pep titration with both techniques * be included in the study for 28 days

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Key information

Conditions

ARDS (Acute Respiratory Distress Syndrome) Acute Lung Injury Lung Diseases Lung Injury Respiratory Tract Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

GHU Henri Mondor, Créteil, France

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About this study

Personalizing the PEEP level is an important step in ventilator adjustment in ARDS patients.

The investigators have developed a simple, low-cost method to detect overdistension of the lung, consisting of applying manual compression to the anterior aspect of the patient's thorax, and observing whether the ventilator pressure increases or decreases.

The investigators hypothesize that with this simple method it is possible to determine the PEEP level which corresponds to that determined with EIT.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age ≥ 18 years
  • Moderate to severe ARDS according to the Berlin criteria
  • Patient receiving sedation and continuous curarization
  • Free and informed consent from the patient or their loved one

Exclusion criteria

  • ECMO
  • Pneumothorax
  • Chest trauma in the last 3 months
  • Uncontrolled shock (noradrenaline > 5 mg/h)
  • Pregnant or breastfeeding woman
  • Protected adult within the meaning of the law
  • Lack of social security
  • Patient under AME

Treatment and study plan

PEEP titrations

Other

Assessment of ideal PEEP using electrical impedance tomography will be performed. The evaluation of PEEP using the thorax compression maneuver method will be carried out. A blood sample (the "blood gases") will be taken at the ideal PEEP determined by electrical impedance tomography and at the ideal PEEP determined by the manual chest compression maneuver.

Primary outcomes

  1. PEPCTAC

    Time frame: Day 0

    PEPCTAC (unit : cmH2O)

  2. PEPCAC

    Time frame: Day 0

    PEPCAC (unit : cmH2O)

  3. PEPEIT

    Time frame: Day 0

    PEPEIT (unit : cmH2O)

Secondary outcomes

  1. Percentage of collapse at PEPCTAC

    Time frame: Day 0

    Percentage of collapse at PEPCTAC

  2. Percentage of collapse at PEPCAC

    Time frame: Day 0

    Percentage of collapse PEPCAC

  3. Percentage of collapse at PEPEIT

    Time frame: Day 0

    Percentage of collapse at PEPEIT

  4. Compare respiratory mechanics for PEPCTAC and PEPCAC and PEPEIT

    Time frame: Day 0

    Respiratory mechanics at PEPCTAC and PEPCAC ans PEPEIT : peak and plateau pressure, driving pressure, respiratory system compliance, pulmonary and parietal compliance, respiratory system resistance, end-expiratory transpulmonary pressure, stress index at each PEEP level

  5. Compare PEPCTAC and other PEEP adjustment methods reported in the literature

    Time frame: Day 0

    Comparison of the PEPCTAC level to the PEP level according to the maximum recruitment arm of the Express study (PEP level which is accompanied by a Pplat between 28 and 30 cm H2O), Comparison of the PEPCTAC level to the PEP level according to the PEP/FiO2 scales, Comparison of the PEPCTAC level to the minimum PEEP level to obtain a positive end-expiratory transpulmonary pressure

  6. Evaluate the effect of CTAC on plateau pressure based on levels of distension and collapse resulting from PEEP

    Time frame: Day 0

    • Correlation between variation of plateau pressure with CTAC and percentage of distension linked to PEEP

  7. Evaluate the effect of CTAC on plateau pressure based on levels of collapse resulting from PEEP

    Time frame: Day 0

    • Correlation between variation of plateau pressure with CTAC and percentage of collapsus linked to PEEP

  8. Evaluate the effect of CTAC on plateau pressure based on the distribution of ventilation between dependent and non-dependent zones resulting from PEEP

    Time frame: Day 0

    Correlation between variation of plateau pressure with CTAC and percentage of anterior ventilation

  9. Evaluate the effects of CTAC on regional compliance according to the level of PEP

    Time frame: Day 0

    Regional compliances (four areas of interest with antero-posterior distribution) of the respiratory and pulmonary system estimated using EIT, airway pressure and esophageal pressure

  10. Evaluate the effect of recruitability potential on the level of PEPCTAC and PEPEIT

    Time frame: Day 0

    R/I ratio

  11. Evaluate the effect of airway opening pressure on the level of PEPCTAC and PEPEIT

    Time frame: Day 0

    Evaluation of the airway opening pressure by performing a slow flow pressure-volume curve (quasi-static condition) from a PEEP set at zero cm H2O

  12. Evaluate the effects of PEEP on right ventricular function

    Time frame: Day 0

    Right ventricular function assessed by echocardiography: mitral inflow, subaortic VTI, subpulmonary VTI, continuous-wave pulmonary Doppler and assessment of pulmonary regurgitation, continuous Doppler, TAPSE (tricuspid annular plane systolic excursion), tricuspid annular S-wave. Presence of acute cor pulmonale defined by an RV/LV ratio > 0.6 associated with paradoxical septal motion, PAPi (pulmonary artery pulsatility index). Septal and free-wall right ventricular strains.

  13. Evaluate the effect of PEEP on venous congestion

    Time frame: Day 0

    Venous congestion assessed by ultrasound (VExUS score)

  14. Compare the percentages of distension between PEPCTAC and PEPCAC and PEPEIT

    Time frame: Day 0

    Percentages of distension between PEPCTAC and PEPCAC and PEPEIT

Study contacts

Contact information is provided by the study sponsor or research team.

Emmanuel Vivier, MD

CONTACT

[email protected]

+33(0)478618209

Fanny Doroszewski, Mrs

CONTACT

[email protected]

+33(0)478618398 ext. +33(0)47861820

Sponsors and collaborators

Lead sponsor

Centre Hospitalier Saint Joseph Saint Luc de Lyon

Other

Registry information

Acronym: TICTAC

Important dates

Study start
2025
Primary completion
2027
Study completion
2027
First posted
Jun 3, 2026
Registry last updated
Jun 3, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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