Clinical Trials Logo

Clinical Trial Summary

The Acute Respiratory Distress Syndrome (ARDS) impacts one of every four patients requiring mechanical ventilation for respiratory support and carries a mortality rate of 40%. To diagnose ARDS, doctors currently use the Berlin definition, that requires chest radiographs and analysis of oxygenation in the blood (arterial blood gas). These tests are not available in areas of the world with constrained resources and may be unnecessarily invasive. A modification of the Berlin definition, using ultrasound and pulse oximetry (a small device that measures oxygen level non-invasively by clipping to the body, typically a finger), has been recently developed and tested in Kigali, Rwanda. This study will try to confirm the validity of the Kigali modification initially in Boston and Toronto and subsequently in other hospitals worldwide. If confirmed, this new definition could allow for faster recognition and potentially improved treatment of patients with ARDS and facilitate studies worldwide. The purposes of this study are: 1. To describe clinical characteristics and outcomes of patients diagnosed with ARDS according to the Berlin and Kigali definitions; 2. To determine how well chest radiograph and ultrasound of the chest are able to define ARDS, in comparison to chest computer tomography (CT).


Clinical Trial Description

We hypothesize that the hospital-wide incidence of ARDS, as defined by the Kigali modification, is similar in high resource settings (e.g., Boston and Toronto) as compared to the resource-constrained setting of Kigali, Rwanda. We also hypothesize that pulmonary ultrasound is a more sensitive and similarly specific imaging modality for bilateral opacities than chest radiograph, when compared to the reference standard of chest tomography. We will test these hypotheses in a multicenter prospective cohort study with the following specific aims: Aim 1: A) To estimate the hospital-wide incidence of ARDS defined according to both the Berlin definition and the Kigali modification, and B) To describe clinical characteristics and outcomes for these patients. Aim 2: For the subset of patients who have chest CT, to determine the sensitivity and specificity for bilateral opacities of both chest radiographs and chest ultrasound done within 12 hours as compared to the reference standard CT scans. As a part of the research study, we will perform a pilot study with the specific aim of assessing feasibility of a multicenter study. Criteria that will be used to assess feasibility include: 1. Number of hospitalised adult patients who fulfill Kigali or Berlin ARDS criteria over the first 7 days post-hospital admission; 2. Number of hospitalised adult patients who develop hypoxemia as detected on daily screening, during the first 7 days post-hospital admission (% hypoxemic patients/new admissions); 3. Proportion of recruited patients/eligible patients (see below for eligibility criteria); 4. Work-load per patient (lung ultrasound scanning time; average data collection time on the first day of hypoxemia); 5. Proportion of patients with CXR, CT scan and LUS available from the same +/-1 day. All adults (≥ 18 years old) admitted to the hospital during either of two one-week study periods (winter and summer) will be screened daily for hypoxemia (defined as oxygen saturation < 90%) or use of any supplemental oxygen for a total of 7 days. For the initial feasibility phase, both in-person and electronic administrative records screening will be performed. Depending on the site and the results of the pilot phase, in the multicenter study the screening will be accomplished using electronic administrative records or in-person screening. For any eligible patient who screens positive during the study period we will collect data as detailed in the table below: Day 1 post-hypoxemia detection - Demographic characteristics (year of birth, sex, height, weight) - Admission data (type of admission - elective/emergency; transfer vs direct admission vs ED admission -; date of admission; if transfer from other hospital; ward - medicine, surgery, ICU) - Main diagnosis/clinical presentation - Co-morbidities - ARDS risk factors at admission - New or worsening symptoms within 7 days - Institution of mechanical ventilation (invasive or non-invasive) - Oxygenation data - Lung Ultrasound data - CXR and CT scans occurring up to 24 hours before onset of hypoxemia Day 2-6 post-hypoxemia detection - Oxygenation data - Lung Ultrasound data - Chest imaging Day 7 post-hypoxemia detection - Etiology of hypoxemia (as determined by MRP) - New ARDS risk factors identified - Need for ICU admission first 7 days - Institution of mechanical ventilation first 7 days (invasive and non-invasive) - Oxygenation data - Lung Ultrasound data - Structured focused lung ultrasound - Chest imaging Outcome data collection - Vital status at hospital separation, censored at 90 days - Date of hospital discharge (or death) - ICU admission and duration of ICU stay For any eligible patient who does not screen positive during any day of the study period (days 1-7 post hospital admission), we will collect the following data: - Vital status at hospital separation, censored at 90 days - Date of hospital discharge (or death) - ICU admission and duration of ICU stay For patients undergoing CT chest during the 7 days of data collection, we will attempt the performance of an extra lung ultrasound examination immediately before or after the CT scan ;


Study Design


Related Conditions & MeSH terms


NCT number NCT03546699
Study type Observational
Source University Health Network, Toronto
Contact
Status Active, not recruiting
Phase
Start date October 24, 2018
Completion date October 15, 2023

See also
  Status Clinical Trial Phase
Completed NCT03909854 - Pragmatic Investigation of Volume Targeted Ventilation-1 N/A
Recruiting NCT03662438 - HOPE (Home-based Oxygen [Portable] and Exercise) for Patients on Long Term Oxygen Therapy (LTOT) N/A
Recruiting NCT05308719 - Nasal Oxygen Therapy After Cardiac Surgery N/A
Recruiting NCT05535543 - Change in the Phase III Slope of the Volumetric Capnography by Prone Positioning in Acute Respiratory Distress Syndrome
Completed NCT04030208 - Evaluating Safety and Efficacy of Umbulizer in Patients Requiring Intermittent Positive Pressure Ventilation N/A
Recruiting NCT04542096 - Real Time Evaluation of Dynamic Changes of the Lungs During Respiratory Support of VLBW Neonates Using EIT
Recruiting NCT04668313 - COVID-19 Advanced Respiratory Physiology (CARP) Study
Recruiting NCT05883137 - High-flow Nasal Oxygenation for Apnoeic Oxygenation During Intubation of the Critically Ill
Completed NCT04505592 - Tenecteplase in Patients With COVID-19 Phase 2
Completed NCT03943914 - Early Non-invasive Ventilation and High-flow Nasal Oxygen Therapy for Preventing Delayed Respiratory Failure in Hypoxemic Blunt Chest Trauma Patients. N/A
Active, not recruiting NCT03472768 - The Impact of Age-dependent Haptoglobin Deficiency on Plasma Free Hemoglobin Levels During Extracorporeal Membrane Oxygenation Support
Not yet recruiting NCT04538469 - Absent Visitors: The Wider Implications of COVID-19 on Non-COVID Cardiothoracic ICU Patients, Relatives and Staff
Not yet recruiting NCT02542423 - Endocan Predictive Value in Postcardiac Surgery Acute Respiratory Failure. N/A
Completed NCT02265198 - Relationship of Pulmonary Contusion to Pulmonary Inflammation and Incidence of Acute Respiratory Distress Syndrome N/A
Completed NCT02105298 - Effect of Volume and Type of Fluid on Postoperative Incidence of Respiratory Complications and Outcome (CRC-Study) N/A
Completed NCT01885442 - TryCYCLE: A Pilot Study of Early In-bed Leg Cycle Ergometry in Mechanically Ventilated Patients N/A
Completed NCT01659268 - Performance of Baccalaureate Nursing Students in Insertion of Laryngeal Mask: a Trial in Mannequins N/A
Completed NCT02814994 - Respiratory System Compliance Guided VT in Moderate to Severe ARDS Patients N/A
Terminated NCT01333059 - Cycling of Sedative Infusions in Critically Ill Pediatric Patients N/A
Completed NCT01204281 - Proportional Assist Ventilation (PAV) in Early Stage of Critically Ill Patients Phase 4