Respiratory Physiotherapy as a Tool to Increase the Number of Solid Organ Donors

Lung Transplant Failure Clinical Trial

Official title:

Respiratory Physiotherapy as a Tool to Increase the Number of Solid Organ Donors

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06202859
• Other study ID #: MIE-don study
• Status: Recruiting
• Phase: N/A
• Start date: November 1, 2022
• Est. completion date: April 2025

Study information

• Verified date: January 2024
• Source: Vall d'Hebron Institute Research
• Contact: Irene bello, Professor
• Phone: 620664172
• Email: irene.bello.rodriguez[@]gmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The main objective of the project is to determine the variation of PaO2 / FiO2 (PaFi) after the use of mechanical insufflation-exsufflation (MI-E) or mechanical cough assistant in the donor in brain death (DBD) and in the potential donor in control donor after circulatory death (cDCD) It is a randomized prospective multicentre study. Four centres with a solid organ donation program will participate in the study, the Hospital Clínic i Provincial de Barcelona (HCB), the Germans Tries y Pujol Hospital (HGTP), the Marqués de Valdecilla Hospital (HMV) and the Vall d'Hebron Hospital (HVH). One hundred and sixty consecutive eligible donors will be included in DBD and cDCD older than 18 years.

• P1: Eighty donors will be maintained following national guidelines.

• P2: Eighty donors will be maintained following national guidelines and:

• Manual techniques of secretion drainage

• Two sequences separated for 1 min of 6 cycles each of MI-E(Cough Assist E70, Respironics Philips.

Demographic variables of the donor and recipient will be collected, as well as differences in PaFi, static compliance, and radiographic changes between P1 and P2 donors. The percentage of lung donors recovered by P2 with respect to P1 will be analyzed.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 160
• Est. completion date: April 2025
• Est. primary completion date: April 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Organ donor older than 18yo

Exclusion Criteria:

• Absolute contraindications for MIE's use

• Absolute contraindications for organ donation

Related Conditions & MeSH terms

• Lung Transplant Failure

Intervention

Device:
• MIE
Two sequences separated for 1 min of 6 cycles each of MI-E(Cough Assist E70, Respironics Philips.

Locations

Country	Name	City	State
Spain	Irene bello	Barcelona

Sponsors (4)

Lead Sponsor	Collaborator
Vall d'Hebron Institute Research	Germans Trias i Pujol Hospital, Hospital Universitario Marqués de Valdecilla, Hospital Vall d'Hebron

Country where clinical trial is conducted

Spain, 

References & Publications (20)

Bach JR, Saporito LR, Shah HR, Sinquee D. Decanulation of patients with severe respiratory muscle insufficiency: efficacy of mechanical insufflation-exsufflation. J Rehabil Med. 2014 Nov;46(10):1037-41. doi: 10.2340/16501977-1874. — View Citation

Bach JR. Noninvasive Respiratory Management of Patients With Neuromuscular Disease. Ann Rehabil Med. 2017 Aug;41(4):519-538. doi: 10.5535/arm.2017.41.4.519. Epub 2017 Aug 31. — View Citation

Battaglini D, Robba C, Caiffa S, Ball L, Brunetti I, Loconte M, Giacobbe DR, Vena A, Patroniti N, Bassetti M, Torres A, Rocco PR, Pelosi P. Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19. Respir Physiol Neurobiol. 2020 Nov;282:103529. doi: 10.1016/j.resp.2020.103529. Epub 2020 Aug 17. — View Citation

Benazzo A, Schwarz S, Frommlet F, Sinn K, Schweiger T, Klikovits T, Hoda AM, Moser B, Matilla JR, Renyi Vamos F, Lang G, Jaksch P, Di Nardo M, Del Sorbo L, Taghavi S, Keshavjee S, Klepetko W, Cypel M, Hoetzenecker K. Donor ventilation parameters as predictors for length of mechanical ventilation after lung transplantation: Results of a prospective multicenter study. J Heart Lung Transplant. 2021 Jan;40(1):33-41. doi: 10.1016/j.healun.2020.10.008. Epub 2020 Oct 28. — View Citation

Fernandez-Carmona A, Olivencia-Pena L, Yuste-Ossorio ME, Penas-Maldonado L; Grupo de Trabajo de Unidad de Ventilacion Mecanica Domiciliaria de Granada. Ineffective cough and mechanical mucociliary clearance techniques. Med Intensiva (Engl Ed). 2018 Jan-Feb;42(1):50-59. doi: 10.1016/j.medin.2017.05.003. Epub 2017 Jun 12. English, Spanish. — View Citation

Ferreira de Camillis ML, Savi A, Goulart Rosa R, Figueiredo M, Wickert R, Borges LGA, Galant L, Teixeira C. Effects of Mechanical Insufflation-Exsufflation on Airway Mucus Clearance Among Mechanically Ventilated ICU Subjects. Respir Care. 2018 Dec;63(12):1471-1477. doi: 10.4187/respcare.06253. Epub 2018 Jul 17. — View Citation

Goncalves MR, Honrado T, Winck JC, Paiva JA. Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial. Crit Care. 2012 Dec 12;16(2):R48. doi: 10.1186/cc11249. — View Citation

Guerin C, Bourdin G, Leray V, Delannoy B, Bayle F, Germain M, Richard JC. Performance of the coughassist insufflation-exsufflation device in the presence of an endotracheal tube or tracheostomy tube: a bench study. Respir Care. 2011 Aug;56(8):1108-14. doi: 10.4187/respcare.01121. — View Citation

Lachal R, Louis B, Subtil F, Guerin C. Bench Assessment of the Effect of a Collapsible Tube on the Efficiency of a Mechanical Insufflation-Exsufflation Device. Respir Care. 2019 Jul;64(7):752-759. doi: 10.4187/respcare.06478. Epub 2019 Mar 12. — View Citation

Minambres E, Ballesteros MA, Rodrigo E, Garcia-Miguelez A, Llorca J, Ruiz JC, Arias M. Aggressive lung donor management increases graft procurement without increasing renal graft loss after transplantation. Clin Transplant. 2013 Jan-Feb;27(1):52-9. doi: 10.1111/j.1399-0012.2012.01690.x. Epub 2012 Aug 16. — View Citation

Minambres E, Perez-Villares JM, Chico-Fernandez M, Zabalegui A, Duenas-Jurado JM, Misis M, Mosteiro F, Rodriguez-Caravaca G, Coll E. Lung donor treatment protocol in brain dead-donors: A multicenter study. J Heart Lung Transplant. 2015 Jun;34(6):773-80. doi: 10.1016/j.healun.2014.09.024. Epub 2014 Sep 28. — View Citation

Morrow B, Zampoli M, van Aswegen H, Argent A. Mechanical insufflation-exsufflation for people with neuromuscular disorders. Cochrane Database Syst Rev. 2013 Dec 30;(12):CD010044. doi: 10.1002/14651858.CD010044.pub2. — View Citation

Nunes LC, Rizzetti DA, Neves D, Vieira FN, Kutchak FM, Wiggers GA, Pecanha FM. Mechanical insufflation/exsufflation improves respiratory mechanics in critical care: Randomized crossover trial. Respir Physiol Neurobiol. 2019 Aug;266:115-120. doi: 10.1016/j.resp.2019.05.008. Epub 2019 May 13. — View Citation

Rose L. Strategies for weaning from mechanical ventilation: a state of the art review. Intensive Crit Care Nurs. 2015 Aug;31(4):189-95. doi: 10.1016/j.iccn.2015.07.003. Epub 2015 Jul 21. — View Citation

Sanchez-Garcia M, Santos P, Rodriguez-Trigo G, Martinez-Sagasti F, Farina-Gonzalez T, Del Pino-Ramirez A, Cardenal-Sanchez C, Busto-Gonzalez B, Requesens-Solera M, Nieto-Cabrera M, Romero-Romero F, Nunez-Reiz A. Preliminary experience on the safety and tolerability of mechanical "insufflation-exsufflation" in subjects with artificial airway. Intensive Care Med Exp. 2018 Apr 3;6(1):8. doi: 10.1186/s40635-018-0173-6. — View Citation

Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013 Sep;144(3):825-847. doi: 10.1378/chest.12-2930. — View Citation

Terzi N, Prigent H, Lofaso F. Mechanical Insufflation-Exsufflation to Improve Secretion Clearance During Invasive Ventilation. Respir Care. 2018 Dec;63(12):1577-1578. doi: 10.4187/respcare.06700. No abstract available. — View Citation

Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, Hodgson C, Jones AY, Kho ME, Moses R, Ntoumenopoulos G, Parry SM, Patman S, van der Lee L. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020 Apr;66(2):73-82. doi: 10.1016/j.jphys.2020.03.011. Epub 2020 Mar 30. — View Citation

Toussaint M. The use of mechanical insufflation-exsufflation via artificial airways. Respir Care. 2011 Aug;56(8):1217-9. doi: 10.4187/respcare.01448. No abstract available. — View Citation

Volpe MS, Naves JM, Ribeiro GG, Ruas G, Amato MBP. Airway Clearance With an Optimized Mechanical Insufflation-Exsufflation Maneuver. Respir Care. 2018 Oct;63(10):1214-1222. doi: 10.4187/respcare.05965. Epub 2018 Jul 17. — View Citation

* Note: There are 20 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The changes in Oxygenation	The changes of oxygenation comparing MIE to national protocol	Ten minutes after the MIE application and 60 minutes after MIE application or national protocol aplication
Secondary	Rate of complications with the use of MIE	To analyse the complications associated with the use of MIE in organ donors	During the intervention and 60 minutes after it.
Secondary	Number of potential lung donors	To analyse the increase in potential lung donors with MIE	during the recruitment time
Secondary	Number of lung donors	To analyse the increase in lung donors with MIE	during the recruitment time