Closed-Loop O2 Use During Invasive Mechanical Ventilation Of Pediatric Patients

Respiratory Failure Clinical Trial

— CLOUDIMPP  

Official title:

Closed-Loop O2 Use During Invasive Mechanical Ventilation Of Pediatric Patients (CLOUDIMPP)- a Randomized Cross-over Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05714527
• Other study ID #: 2022/750
• Status: Recruiting
• Phase: N/A
• Start date: January 30, 2023
• Est. completion date: August 31, 2024

Study information

• Verified date: April 2024
• Source: Dr. Behcet Uz Children's Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

During mechanical ventilation (MV) hypoxemic or hyperoxemic events should be carefully monitored and a quick response should be provided by the caregiver at the bedside. Pediatric mechanical ventilation consensus conference (PEMVECC) guidelines suggest to measure SpO2 in all ventilated children and furthermore to measure partial arterial oxygen pressure (PaO2) in moderate-to-severe disease. There were no predefined upper and lower limits for oxygenation in pediatric guidelines, however, Pediatric acute lung injury consensus conference PALICC guidelines proposed SpO2 between 92 - 97% when positive end-expiratory pressure (PEEP) is smaller than 10 cm H2O and SpO2 of 88 - 92% when PEEP is bigger or equal to 10 cm H2O. For healthy lung, PEMVECC proposed the SpO2>95% when breathing a FiO2 of 21%. As a rule of thumb, the minimum fraction of inspired O2 (FiO2) to reach these targets should be used. A recent Meta-analyze showed that automated FiO2 adjustment provides a significant improvement of time in target saturations, reduces periods of hyperoxia, and severe hypoxia in preterm infants on positive pressure respiratory support. This study aims to compare the closed-loop FiO2 controller with conventional control of FiO2 during mechanical ventilation of pediatric patients

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 30
• Est. completion date: August 31, 2024
• Est. primary completion date: June 20, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 1 Month to 18 Years

Eligibility

Inclusion Criteria:

• Pediatric patients older than 1 month and younger than18 years of age; hospitalized at the PICU with the intention of treatment with IMV at least for the upcoming 5 hours

• Requiring FiO2 = 25% to keep SpO2 in the target ranges defined by the clinician

• Written informed consent signed and dated by the patient or one relative in case that the patient is unable to consent, after full explanation of the study by the investigator and prior to study participation

Exclusion Criteria:

• Patient with indication for immediate noninvasive ventilation (NIMV), High flow oxygen therapy (HFOT)

• Hemodynamic instability defined as a need of continuous infusion of epinephrine or norepinephrine > 1 mg/h

• Low quality on the SpO2 measurement using finger and ear sensor (quality index below 60% on the SpO2 sensor, which is displayed by a red or orange colour bar)

• Severe acidosis (pH = 7.25)

• Pregnant woman

• Patients deemed at high risk for the need of non-invasive mechanical ventilation within the next 5 hours

• Patients deemed at high risk for the need of transportation from PICU to another ward, diagnostic unit or any other hospital

• Diseases or conditions which may affect transcutaneous SpO2 measurement such as chronic or acute dyshemoglobinemia: methemoglobinemia, carbon monoxide (CO) poisoning, sickle cell disease

• Formalized ethical decision to withhold or withdraw life support

• Patient included in another interventional research study under consent

• Patient already enrolled in the present study in a previous episode of acute respiratory failure

Related Conditions & MeSH terms

• Respiratory Failure
• Respiratory Insufficiency

Intervention

Device:
• Close-loop FiO2 controller
Close-loop FiO2 controller software option provides automated adjustment of the ventilator Oxygen setting to maintain the patient's SpO2 in a defined target range. When using the software option, the user defines the SpO2 target range, as well as the SpO2 emergency limits, and the device adjusts the FiO2 setting to keep the patient's SpO2 in the target range.
• Conventional
Conventional FiO2 adjustment by the clinician according to SpO2 values, by using the manual FiO2 knob.

Locations

Country	Name	City	State
Turkey	Aydin Obstetric and pediatrics Hospital	Aydin
Turkey	Erzurum Regional Research and Training Hospital	Erzurum
Turkey	Cam Sakura Research and Training Hospital	Istanbul
Turkey	The Health Sciences University Izmir Behçet Uz Child Health and Diseases Research and Training Hospital	Izmir

Sponsors (2)

Lead Sponsor	Collaborator
Dr. Behcet Uz Children's Hospital	Hamilton Medical AG

Country where clinical trial is conducted

Turkey, 

References & Publications (5)

Kneyber MCJ, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J, Hammer J, Macrae D, Markhorst DG, Medina A, Pons-Odena M, Racca F, Wolf G, Biban P, Brierley J, Rimensberger PC; section Respiratory Failure of the European Society for Paediatric and Neonatal Intensive Care. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med. 2017 Dec;43(12):1764-1780. doi: 10.1007/s00134-017-4920-z. Epub 2017 Sep 22. — View Citation

Lui K, Jones LJ, Foster JP, Davis PG, Ching SK, Oei JL, Osborn DA. Lower versus higher oxygen concentrations titrated to target oxygen saturations during resuscitation of preterm infants at birth. Cochrane Database Syst Rev. 2018 May 4;5(5):CD010239. doi: 10.1002/14651858.CD010239.pub2. — View Citation

Maiwald CA, Niemarkt HJ, Poets CF, Urschitz MS, Konig J, Hummler H, Bassler D, Engel C, Franz AR; FiO2-C Study Group. Effects of closed-loop automatic control of the inspiratory fraction of oxygen (FiO2-C) on outcome of extremely preterm infants - study protocol of a randomized controlled parallel group multicenter trial for safety and efficacy. BMC Pediatr. 2019 Oct 21;19(1):363. doi: 10.1186/s12887-019-1735-9. — View Citation

Sandal O, Ceylan G, Topal S, Hepduman P, Colak M, Novotni D, Soydan E, Karaarslan U, Atakul G, Schultz MJ, Agin H. Closed-loop oxygen control improves oxygenation in pediatric patients under high-flow nasal oxygen-A randomized crossover study. Front Med (Lausanne). 2022 Nov 16;9:1046902. doi: 10.3389/fmed.2022.1046902. eCollection 2022. — View Citation

van Kaam AH, Hummler HD, Wilinska M, Swietlinski J, Lal MK, te Pas AB, Lista G, Gupta S, Fajardo CA, Onland W, Waitz M, Warakomska M, Cavigioli F, Bancalari E, Claure N, Bachman TE. Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants. J Pediatr. 2015 Sep;167(3):545-50.e1-2. doi: 10.1016/j.jpeds.2015.06.012. Epub 2015 Jul 2. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percentage of time spent in optimal SpO2 range	The optimal SpO2 range will be defined according to the SpO2 targets determined by the clinician.	2 hours
Secondary	Percentage of time spent in suboptimal SpO2 range	SpO2 values outside the optimal range but still within an acceptable limit (2-3 percent above and below the optimal range)	2 hours
Secondary	Mean FiO2	Mean fraction of inspired oxygen	2 hours
Secondary	Mean SpO2/FiO2	Mean SpO2/FiO2	2 hours
Secondary	Number of manual adjustments	Frequency of manual adjustments of FiO2	2 hours
Secondary	Number of alarms	Frequency of alarms	2 hours
Secondary	Percentage of time with SpO2 signal available	Time with SpO2 signal available	2 hours
Secondary	Percentage of time with SpO2 below 88 and 85 percent	Duration of time with SpO2 <85 percent and <88 percent, respectively	2 hours
Secondary	Number of events with SpO2 below 88 and 85 percent	Frequency of SpO2 decreases <85 percent and <88 percent, respectively	2 hours
Secondary	Percentage of time with FiO2 below 40 percent, 60 percent and 100 percent	Percentage of time that FiO2 is <40 percent, 60 percent and 100 percent, respectively	2 hours
Secondary	Total oxygen use	Volume of total oxygen used (in L)	2 hours