Vascular ARDS Recruitment After Inhaled Nitric Oxide

Conditions

• Acute Respiratory Distress Syndrome
• Ventilation Perfusion Mismatch

Eligibility Criteria

Sex

ALL

Age

18 Years - 80 Years

Healthy Volunteers

Not accepted

Interventions

• Nitric Oxide — DEVICE
  20ppm for 15 minutes delivered by INO max(Nitric Oxide) Company : INO therapeutics, Inc.

Study Details

Acute respiratory distress syndrome (ARDS) is when a person's lungs become inflamed, which can be caused by infection, trauma, surgery, blood transfusion, or burn. ARDS often leads to a situation where the person cannot breathe independently and needs machines' help. Once the lungs are inflamed, the small air sacs responsible for exchanging gases (i.e., ventilation) and the blood flow in the lungs (i.e., perfusion) can be affected. In the past, most research focused on studying ventilation physiology and how to help people breathe with machines. Less was done on perfusion because it requires imaging techniques such as computed tomography with intravenous contrast and radiation. One treatment option for low oxygen levels is inhaled nitric oxide (iNO), a gas that can dilate the lung blood vessels and improve oxygenation; however, it is not always clear whether this treatment will work. Prone position has been used for several years in the care of ARDS patients and has been demonstrated to improve survival in more severe patients. It is not known how iNO and prone positioning interact in determining the distribution of pulmonary perfusion and whether their combine use can benefit ARDS patients. Electrical Impedance Tomography (EIT) is a bedside and accessible imaging technique that is radiation-free and non-invasive and can potentially detect changes in lung perfusion. EIT can perform multiple measurements; it is portable and accessible. This prospective interventional study aims to assess changes in regional blood perfusion in the lungs of patients with ARDS in response to iNO and to prone positioning utilizing EIT. The main questions it aims to answer are: 1. If EIT can measure lung regional perfusion response to an iNO challenge of 20ppm for 15 minutes. 2. If EIT can measure the lung regional perfusion responses to prone position, applied alone and in combination with iNO. 3. If EIT is comparable to dual-energy computed tomography (DECT), the gold-standard method, in the detection of changes in regional lung perfusion due to iNO. 4. If EIT can be an imaging marker to identify ARDS severity Participants will be divided into three cohorts: 1. Sub-Cohort 1 (n=60): Participants will be asked to be monitored by EIT before, during, and after the administration of iNO (20 ppm) for 15 minutes (OFF-ON-OFF) in the supine position 2. Sub-Cohort 2 (N=10): Participants will be asked to be monitored by EIT before and during the administration of iNO (20 ppm) for 15 minutes (OFF-ON) in both the supine and in the prone position. The same subjects will be monitored also with DECT in the supine position and then after 30 minutes in the prone position (without NO administration). 3. Sub-Cohort 3 (N=10): In this subset of Sub-Cohort 1, subjects will be asked to be monitored also with DECT (in addition to EIT) in the supine body position before iNO and after 15 minutes while receiving iNO.

Key Dates

First listed

Apr 6, 2023

Start date

Jul 10, 2026

Status verified

Aug 2026

Primary completion

Dec 31, 2028

Completion

Dec 31, 2028

Study Design

Enrollment

70 participants (estimated)

Allocation

NON_RANDOMIZED

Intervention model

PARALLEL

Primary purpose

DIAGNOSTIC

Arms

• Experimental: Electrical Impedance Tomography
  A total of 60 subjects (Sub-Cohort 1) will receive an inhaled nitric oxide (iNO) challenge (20 ppm) for 15 min. The investigators will measure ventilation and perfusion distributions using EIT before iNO ("OFF1"), after 15 min on iNO ("ON"), and after 15 min washout ("OFF2") to confirm baseline stability.
• Experimental: Electrical Impedance Tomography and Dual-Energy Computed Tomography in the Supine and Prone position
  In a subset of 10 subjects (Sub-Cohort 2), EIT will be performed without and with iNO (OFF-ON) both in the supine and in the prone position. The OFF-ON fashion for EIT imaging is to minimize the subject's exposure to hypertonic saline solution. Sub-cohort 2 patient will be imaged also with DECT in the supine and after 30 minutes in the prone position. iNO will not be administered during DECT.
• Experimental: Electrical Impedance Tomography with and without Inhaled Nitric Oxide in the Supine Position
  10 subjects (Sub-Cohort 3) from Sub-Cohort 1 will be monitored without iNO, with iNO, and without iNO (OFF-ON-OFF) in the supine position. Sub-Cohort 3 subjects will be imaged also with DECT. Imaging will be performed in the supine position without iNO and following iNO administration for 15 minutes (OFF-ON) .

Primary Outcome Measure

Change in regional lung perfusion after the delivery of inhaled nitric oxide [ Time Frame: Day 1 ]

Central Contacts

• Maurizio F Cereda, MD
  6177263030
  [email protected]
• Roberta Ribeiro De Santis Santiago, MD, PhD
  6176437733
  [email protected]

Locations (1)

Find similar trials in Boston, MA

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