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Clinical Trial Details — Status: Suspended

Administrative data

NCT number NCT04026217
Other study ID # 2745
Secondary ID
Status Suspended
Phase
First received
Last updated
Start date May 27, 2019
Est. completion date January 31, 2024

Study information

Verified date January 2024
Source Azienda Sanitaria-Universitaria Integrata di Udine
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Acute hypoxemic respiratory failure due to parenchymal disfunction is one of the main complications of immunocompromised hematological patients. Mechanical ventilation is frequently needed and diaphragm activity has to be assessed not to worsen ventilator-induced lung injury.


Description:

Acute hypoxemic respiratory failure due to parenchymal disfunction is one of the main complications of immunocompromised hematological patients. In these cohort of patients mechanical ventilation is frequently needed in order to restore oxygenation and normocapnia. Since every positive-pressure ventilation regimen may potentially determine pulmonary complications, due to alteration in pressure and volume lung homeostasis and diaphragm activity, also diaphragm function has to be assessed not to worsen ventilator-induced lung injury (VILI). Main targets of VILI are pulmonary interstitium and diaphragm. Pulmonary interstitium is frequently involved in different mechanism of injury, that derive both from induced tidal volume and positive end expiratory pressure (PEEP). Indeed, large tidal volumes generated during assisted spontaneous breathing may configure non-protective ventilation regimens and the so called "pendelluft phenomenon", that is the intrinsic flow of air within the lung from nondependent to dependent regions without changes in tidal volume, may affect inadequate PEEP values. Positive-pressure ventilation may also alter diaphragm activity. Recent data show that diaphragm disfunction, considered as an enhanced or reduced thickening fraction, occurs in about 65% of patients undergoing mechanical ventilation. Since the potential harm of positive-pressure ventilation, the optimization of mechanical ventilation is pivotal to ensure an adequate time-to-recovery without concurring to the onset of further lung and diaphragmatic injury. Neurally Adjusted Ventilatory Assist (NAVA) is a recent modality of mechanical ventilation that delivers ventilatory assistance according to the respiratory effort of the patient, measured by electrical activity of the diaphragm (EAdi). NAVA works proportionally with EAdi values, ensuring a better neuroventilatory efficiency compared to other mechanical ventilation modes and also reducing patient-ventilator asynchrony. According to these features NAVA protocol may be useful in preserving gas exchanges and diaphragm function both in invasive and non-invasive ventilation. Therefore the evaluation of basal diaphragm activity, the choice of the device for oxygen support administration and the setting of ventilatory parameters may influence hospital stay and outcome of patients affected by acute hypoxemic respiratory failure. The aim of this study is to evaluate the basal diaphragm activity of acute hypoxemic respiratory failure patients admitted in Intensive Care Unit (ICU) and to record diaphragm activity modifications during the ICU stay in relation to the optimization of medical therapy and, if necessary, according to the need of ventilatory support (invasive or non-invasive ventilation delivered with NAVA protocol). This study intends to register also daily diaphragm thickening fraction, daily arterial blood gas analysis, failure frequency of non-invasive ventilation, frequency of tracheal intubation, length of mechanical ventilation, length of hospital stay and hospital mortality.


Recruitment information / eligibility

Status Suspended
Enrollment 30
Est. completion date January 31, 2024
Est. primary completion date December 27, 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Hypoxemic respiratory failure in hematological patients (PaO2 < 70 mmHg or P/F < 150) Exclusion Criteria: - Patients with positive-pressure ventilation regimen of high flow nasal cannula prior to ICU admission - Unstable clinical condition (use of vasopressors, acute coronary syndrome...) - Refusal of treatment or informed consent - Agitation (RASS =+2) or lack of collaboration (Kelly Matthay = 5) - Multiple organ failure - Enrollment in other study protocols

Study Design


Related Conditions & MeSH terms


Locations

Country Name City State
Italy Anesthesiology and Intensive Care Clinic - Department of Medicine - ASUIUD Udine

Sponsors (1)

Lead Sponsor Collaborator
Azienda Sanitaria-Universitaria Integrata di Udine

Country where clinical trial is conducted

Italy, 

References & Publications (32)

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Di Mussi R, Spadaro S, Mirabella L, Volta CA, Serio G, Staffieri F, Dambrosio M, Cinnella G, Bruno F, Grasso S. Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV. Crit Care. 2016 Jan 5;20:1. doi: 10.1186/s13054-015-1178-0. — View Citation

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Frat JP, Ragot S, Girault C, Perbet S, Prat G, Boulain T, Demoule A, Ricard JD, Coudroy R, Robert R, Mercat A, Brochard L, Thille AW; REVA network. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial. Lancet Respir Med. 2016 Aug;4(8):646-652. doi: 10.1016/S2213-2600(16)30093-5. Epub 2016 May 27. — View Citation

Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, Prat G, Boulain T, Morawiec E, Cottereau A, Devaquet J, Nseir S, Razazi K, Mira JP, Argaud L, Chakarian JC, Ricard JD, Wittebole X, Chevalier S, Herbland A, Fartoukh M, Constantin JM, Tonnelier JM, Pierrot M, Mathonnet A, Beduneau G, Deletage-Metreau C, Richard JC, Brochard L, Robert R; FLORALI Study Group; REVA Network. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015 Jun 4;372(23):2185-96. doi: 10.1056/NEJMoa1503326. Epub 2015 May 17. — View Citation

Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Vorona S, Sklar MC, Rittayamai N, Lanys A, Murray A, Brace D, Urrea C, Reid WD, Tomlinson G, Slutsky AS, Kavanagh BP, Brochard LJ, Ferguson ND. Mechanical Ventilation-induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes. Am J Respir Crit Care Med. 2018 Jan 15;197(2):204-213. doi: 10.1164/rccm.201703-0536OC. — View Citation

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* Note: There are 32 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Diaphragm thickening fraction Diaphragm thickening fraction measured with echography At ICU admission
Secondary Diaphragm thickening fraction Diaphragm thickening fraction measured with echography From date of enrollment until the date of death from any cause or ICU discharge, assessed up to 36 months
Secondary Arterial blood gas analysis Arterial blood gas analysis From date of enrollment until the date of death from any cause or ICU discharge, assessed up to 36 months
Secondary Failure of non-invasive ventilation Failure of non-invasive ventilation according to hospital NIV protocol From date of enrollment until the date of death from any cause or ICU discharge, assessed up to 36 months
Secondary Rate of tracheal intubation Tracheal intubation From date of enrollment until the date of death from any cause or ICU discharge, assessed up to 36 months
Secondary Duration of positive-pressure ventilation Duration of positive-pressure ventilation (NIV or mechanical ventilation) From date of enrollment until the date of death from any cause or ICU discharge, assessed up to 36 months
Secondary Hospital length of stay Hospital length of stay From date of in-hospital admission until the date of hospital discharge, assessed up to 36 months
Secondary In-hospital mortality In-hospital mortality From date of in-hospital admission until the date of death from any cause or hospital discharge, assessed up to 36 months
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