Inhaled Dornase Alpha to Reduce Respiratory Failure After Severe Trauma (TRAUMADORNASE)
A Prospective, Randomized Multicenter, Double Blind Clinical Trial Comparing Inhaled Dornase Alfa and Its Placebo to Reduce the Incidence of Moderate to Severe ARDS in Ventilated Trauma Patients in the Intensive Care Unit
Severe hypoxemia following trauma may happen in many circumstances (aspiration, ventilation-associated pneumonia, lung contusion...), most of which are not exclusively associated with a direct injury to the lungs. Severe trauma and associated musculoskeletal injuries result in the acute release of Damage-Associated Molecular Patterns (DAMPs) in plasma, many of which are made of nucleic acids. DAMPs then bind leukocytes and trigger NETosis (Neutrophil Extracellular Traps), the release of nuclear material coated with proteolytic enzymes, which ultimately promotes remote lung injury and acute respiratory distress syndrome (ARDS).
Considering that many DAMPs and all NETs are made of nucleic acids, we hypothesize that dornase alfa, a commercially available recombinant desoxyribonuclease (DNAse) could reduce DAMPs and NETs-induced lung injury in severe trauma patients under mechanical ventilation in the intensive care unit (ICU).
The primary objective is to demonstrate a reduction in the incidence of moderate to severe ARDS in severe trauma patients during the first seven ICU days from 45% to 30% by providing aerosolized dornase alfa once during the first two consecutive ICU days and compared to equivalent provision of placebo (NaCl 0,9%).
The secondary objectives are to demonstrate, by using aerosolized dornase alfa compared to placebo:
- an improvement in static lung compliance
- a reduction in mechanical ventilation duration / an increase in ventilation-free ICU days
- a reduction in the length of ICU stay
- a reduction in the hospital length of stay
- a reduction in multi-organ failure
- a reduction in ventilator-associated pneumonia (VAP)
- a reduction in mortality at day 28
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Contact
Study Contact
- Name: Julien POTTECHER, MD
- Phone Number: +33 388127095
- Email: julien.pottecher@chru-strasbourg.fr
Study Locations
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-
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Strasbourg, France, 67000
- Recruiting
- University Hospital, Strasbourg, France
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Contact:
- Julien Pottecher, MD
- Phone Number: 03 88 12 70 95
- Email: julien.pottecher@chru-strasbourg.fr
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Adult (>18) patient of either sex affiliated to the National Health Service
- Severe trauma patient (either blunt or penetrating), Injury Severity Score > 15
- Under mechanical ventilation for an expected duration > 48h
- Admitted in the ICU
- Signed informed consent from the patient's relative
- Patient equipped with an indwelling arterial catheter
Exclusion Criteria:
Pregnancy or breast feeding
- Opposition from the patient or his/her relatives
- Protected major (Guardianship)
- Contraindication to the use of dornase alfa
- Known intolerance to dornase alfa
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Dornase alfa
Dornase alfa (Pulmozyme®, Roche 2500U, 2,5mL) given by aerosol in the respiratory circuit (Aerogen solo®) within 6h at day 1 and 24 hours after on day 2.
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Dornase alfa (Pulmozyme®, Roche 2500U, 2,5mL) given by aerosol in the respiratory circuit (Aerogen solo®) within 6h at day 1 and 24 hours after on day 2.
|
|
Placebo Comparator: Placebo
NaCl 0,9%, given by aerosol in the respiratory circuit within 6h at day 1 and 24 hours after on day 2.
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NaCl 0,9%, given by aerosol in the respiratory circuit within 6h at day 1 and 24 hours after on day 2.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
The primary endpoint is the incidence of moderate to severe ARDS (PaO2/FiO2 < 200, according to the Berlin definition [ARDS definition task force et al. JAMA 2015; 307(23): 2526-2533]) in severe trauma patients (Injury Severity Score > 15).
Time Frame: Day 0 to Day 7
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Day 0 to Day 7
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Static lung compliance [mL/cmH2O]
Time Frame: Day 0 to Day 7
|
Day 0 to Day 7
|
|
|
Duration of mechanical ventilation [hours]
Time Frame: Day 0 to Day 7
|
Day 0 to Day 7
|
|
|
Length of ICU stay [hours]
Time Frame: Day 0 to Day 7
|
Day 0 to Day 7
|
|
|
Length of stay in the hospital [days]
Time Frame: Day 0 to Day 7
|
Day 0 to Day 7
|
|
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Incidence of multi-organ failure
Time Frame: Day 0 to Day 7
|
according SOFA (Sepsis-related Organ Failure Assessment) to quantify organ dysfunction
|
Day 0 to Day 7
|
|
Incidence of Ventilator-Associated Pneumonia (VAP)
Time Frame: Day 0 to Day 7
|
Day 0 to Day 7
|
|
|
Mortality on day 28
Time Frame: Day 28
|
Day 28
|
Collaborators and Investigators
Sponsor
Sponsor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 6998
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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