Respiratory Failure Clinical Trial
— TPUGOfficial title:
A Multicenter, Randomized Controlled Trial of Concomitant Bedside Percutaneous Tracheostomy and Ultrasound Gastrostomy
The goal of this research study is to assess the FDA approved technique for inserting a feeding tube (gastrostomy) along with a breathing tube (tracheostomy) for patients that cannot breathe or eat on their own in the ICU (Intensive Care Unit). All subjects in the study will receive a tracheostomy, but each patient will be randomly assigned a common method for gastrostomy placement. The placement of the tube and tracheostomy will occur as part of normal clinical practice. Researchers will compare subjects in the control group and the intervention group to evaluate the benefits of performing a tracheostomy and gastrostomy tube at the same time. Researchers will also evaluate the likelihood of the PUG procedure decreasing a patient's length of stay in the ICU.
Status | Not yet recruiting |
Enrollment | 200 |
Est. completion date | December 1, 2026 |
Est. primary completion date | December 1, 2025 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Informed consent must be obtained from the participant or a Legally Authorized Representative before any trial-specific assessment is performed - Male or female = 18 years of age - Participants with Ventilator Dependent Respiratory Failure (VDRF) - Indication for a bedside percutaneous tracheostomy procedure using an FDA approved percutaneous dilatational tracheostomy device - Indication for percutaneous gastrostomy including Percutaneous Ultrasound (PUG), Percutaneous Radiologic (PRG), and Percutaneous Endoscopic Gastrostomy (PEG) using an FDA approved gastrostomy kit - No contraindications to bedside percutaneous tracheostomy OR gastrostomy - Women of childbearing potential must have negative serum or urine pregnancy test during the current hospitalization Exclusion Criteria: - History of prior gastrostomy, tracheostomy, laryngectomy, gastrostomy prior to tracheostomy decision, known head and neck and gastrointestinal abnormality (cancer, congenital abnormality, anatomic variants). - Hospitalization > 21 days at the time of screening - Known social discharge issues that in the opinion of the investigator will substantially impact the LOS. - Participants with non-survivable injuries or disease, anticipated life expectancy < 30 days. - Uncontrolled coagulopathy - Contraindications for percutaneous gastrostomy procedures - Severe Ascites - Abdominal wall infection at selected site of procedure - Severe gastroparesis - Gastric outlet obstruction - Absolute contraindications to percutaneous dilatational tracheostomy procedure - Cervical instability - Infection at the planned insertion site - Relative contraindications to percutaneous dilatational tracheostomy deemed present by the clinical team - Difficult anatomy (e.g., short neck, morbid obesity, minimal next extension, or tracheal deviation) - Severe respiratory disease resulting in inability to withstand periods of apnea or in the loss of positive pressure ventilation - Pregnancy - Incongruent goals of care between care team and LAR (family representative). - Other procedure related concerns by the primary team that would affect safety of the patient. |
Country | Name | City | State |
---|---|---|---|
United States | University of Maryland Medical Systems | Baltimore | Maryland |
Lead Sponsor | Collaborator |
---|---|
University of Maryland, Baltimore |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Length of stay in ICU | To compare the ICU (Intensive Care Unit) length of stay (days) from the time the decision is made to place a tracheostomy tube and gastrostomy tube to the time of discharge from the ICU for participants receiving TPUG versus a control group. | ICU discharge - up to 24 weeks | |
Secondary | Length of hospital stay | To compare the hospital length of stay (days) and total hospital costs (United States Dollars) from the time the decision is made to place a tracheostomy tube and gastrostomy tube to the time of discharge from the hospital for participants receiving TPUG versus a control group. | Hospital discharge - through study completion, an average of 45 days | |
Secondary | Demographics | To assess confounding variables and differences between groups that could affect outcomes:
Age (categorized as <50 yrs., 51-70 yrs., >70 yrs) Gender (Assigned at birth) Race (Self-Reported) Insurance (categorized as Insured versus Uninsured) Covid status (categorized as Positive, Negative, Indeterminate) Primary diagnosis Primary ICU type Charlson Score SAPS Score |
End of study comparison - through study completion, an average of 45 days |
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