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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04008628
Other study ID # PHRIP18164
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date December 10, 2021
Est. completion date December 2023

Study information

Verified date February 2023
Source Assistance Publique - Hôpitaux de Paris
Contact Ricardo CARBAJAL, Md, Phd
Phone +33144736188
Email ricardo.carbajal@aphp.fr
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Since nitrous oxide/oxygen mixture is effective to reduce pain and anxiety induced by various painful procedures in children, the investigators hypothesized that its inhalation would reduce pain during nasogastric tube placement in young children. The purpose of this study is to evaluate the analgesic efficacy of 50%/50% nitrous/oxide mixture in reducing pain induced by nasogastric tube insertion in children aged 3 months to 3 years in the pediatric emergency department.


Description:

In the context of mild to moderate dehydration in young children, enteral rehydration is the treatment of choice because it is more physiological than parenteral rehydration which has more serious side effects. Thus, nasogastric tube placement has become a more common procedure in the pediatric emergency care setting. Although, it is widely accepted that this procedure is invasive and painful, to date, no analgesic approach has been shown to be effective for children aged 3 months to 3 years. Currently, standard care is the placement of nasogastric tube without any analgesic intervention. Inhalation of nitrous oxide mixed with oxygen (50/50) has been shown to be effective to reduce pain and anxiety induced by invasive procedures in children, adolescents and adults. Its use is very safe and it is associated with only minor and transient side effects such as nausea, vomiting or dizziness in les than 10% of patients. Its use is very common in many countries such as France, United Kingdom, The Netherlands or Australia. The investigators hypothesized that its inhalation would reduce pain during nasogastric tube placement in young children. The purpose of this study is to evaluate the analgesic efficacy of 50%/50% nitrous/oxide mixture in reducing pain induced by nasogastric tube insertion in children aged 3 months to 3 years in the pediatric emergency department. A randomized controlled trial will be performed in two pediatric emergency departments to assess the efficacy of 50/50 nitrous oxide/oxygen during nasogastric tube insertion. The control group will receive standard care. Primary outcome: Pain assessed with the FLACC scale during tube insertion The investigators believe that this randomized study comparing nitrous oxide inhalation against current practice (no analgesic means) will highlight the intensity of pain caused by nasogastric tube placement and will assess the effectiveness of nitrous oxide inhalation to reduce pain and anxiety induced by the procedure


Recruitment information / eligibility

Status Recruiting
Enrollment 160
Est. completion date December 2023
Est. primary completion date December 2023
Accepts healthy volunteers No
Gender All
Age group 3 Months to 3 Years
Eligibility Inclusion Criteria: - Child from 3 months to 3 years old. - Admission to the Pediatric Emergency Department - Medical prescription for the insertion of a nasogastric tube. - Child with gastroenteritis and / or bronchiolitis and / or food intolerance with mild to moderate dehydration - Parental presence and parental consent Exclusion Criteria: - Vital emergency. - Refusal of parents. - Refusal of parents to be filmed - Child already included in the study or in course of participation in another study. - Tube placement performed by a medical student or nursing student. - Patient requiring 100% oxygen ventilation. - No social security. - Child with a mental handicap or known retardation - History of child intolerance to Nitrous oxide ( excessive sedation or respiratory depression during previous use) - Child with head trauma in the previous 3 days Premature discontinuation of study participation : - Parents' request to stop participating in the study. - Insertion of the nasogastric tube is not possible

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Nitrous Oxide
Inhalation of a 50%/50% nitrous oxide/oxygen mixture (Kalinox®)

Locations

Country Name City State
France Ambroise Paré hospital, Pediatric emergency department Boulogne-Billancourt
France Louis Mourier Hospital, Pediatric emergency department Colombes
France Trousseau Hospital, Pediatric emergency department Paris Ile De France
France Poissy Hospital, Pediatric emergency department Poissy Ile De France

Sponsors (2)

Lead Sponsor Collaborator
Assistance Publique - Hôpitaux de Paris URC-CIC Paris Descartes Necker Cochin

Country where clinical trial is conducted

France, 

Outcome

Type Measure Description Time frame Safety issue
Primary Pain during nasogastric tube insertion Pain will be assessed during nasogastric tube insertion with the Face Legs Activity Cry Consolability (FLACC) scale composed of five scale (face, legs, activities, shouting, consolability). Each ranks from 0 to 2 : 0 is no pain, 1 is average pain, 2 is a strong pain The outcome measure is the sum of these five subscales: from 0 (better outcome) to 10 (worse outcome). From the beginning of the procedures until 2 minutes after final positioning of the tube
Secondary Parent's anxiety 10 scale. The parent evaluates himself his anxiety. It's a simple scale graduate one by one, from 0 (better outcome) to 10 (worse outcome). Based on their subjective interpretation of their own anxiety During procedure
Secondary Child's constraint needed during the procedure Scale for grading the level of constraint during the procedure It is composed to three subscales from 0 to 3 (head, arms, legs). 0 is no contention, 1 is soft hold, 2 is firm support, 3 is very firm hold And one subscale from 0 to 1 (trunk). 0 is no contention, 1 is necessary maintenance.
The outcome measure is the sum of these four subscales: from 0 (better outcome, that is to say no contention) to 10 (strongest contention).
During procedure
Secondary The potential side effects of the mixture 50%/50% nitrous oxide/oxygen for a brief inhalation are : Euphoria, dreaming, hallucinations, sedation, headaches, nausea, and vomiting. The rate of side effects will be described from the start of inhalation to nearly 5 to 10 minutes after the end of inhalation