- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00997555
Prophylactic Bronchoscopy After Inhalation Injury in Burn Patients
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The role of bronchoscopy in most hospitals has been limited to obtaining lavage fluid for culture and assessing the degree of airway injury, which has been shown to be predictive of outcome. Severe inhalation injury, which is characterized by pulmonary edema, bronchial edema, and secretions, can occlude the airway and lead to atelectasis and pneumonia. Aggressive use of bronchoscopy is highly effective in removing foreign particles and accumulated secretions that worsen the inflammatory response and impede ventilation. While it seems intuitive that bronchoscopy would improve pulmonary hygiene by removing secretions and denuded epithelial slough in burn patients, there has not been any published data to support or deter the use of bronchoscopy for inhalation injury nor document an improvement in morbidity or mortality secondary to bronchoscopy as a therapeutic intervention.
Recent research has shown that the process of intubation for mechanical ventilation provides a portal for bacterial contamination, after which the damaged tracheobronchial mucosa quickly becomes colonized with pathogenic organisms in over 50% of the patients. Furthermore, within 15 minutes of smoke inhalation, there is significant airway edema and thickening, more prominently in the lower trachea than the upper portion. These factors place the patient with inhalation injury at high risk for pneumonia.
We have used the National Burn Repository data to previously show that patients who receive aggressive use of bronchoscopy after inhalation injury have an improved outcome in terms of decreased ventilator days, decreased ICU length of stay, decreased incidence of pneumonia, and a trend towards improved mortality. However, that data was unable to document why. It was also unable to confirm that the findings were not due to institutional bias. Therefore, one of the conclusions from that study was that a prospective trial is needed to confirm the findings.
Our hypothesis is that a scheduled and sequential use of bronchoscopy after inhalation injury as a therapeutic tool to remove secretions, slough, carbonaceous material, and screen for the early detection of pneumonia by bronchoalveolar lavage (BAL) will improve outcome. We will attempt to document this improvement by using the following endpoints: length of ICU stay, length of hospital stay, ventilator days, incidence of pneumonia, overall morbidity and mortality with and without bronchoscopy.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Michigan
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Flint, Michigan, United States, 48503
- Hurley Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Any burned patient arriving intubated on mechanical ventilation OR requiring mechanical ventilation within 48 hours of admission AND
- > 18 years old AND
patient believed to be able to survive more than 48 hours after arrival (not likely to be made DNR or comfort care) including:
- any methamphetamine explosion or
- any burn associated with fire (not chemical) of the face or blast injury to the face or
- confined in a burning space for more than 10 minutes or
- any burn with carbonaceous material around the nose or mouth or
- any burn > 15% TBSA associated with fire (not chemical) or
- any burn associated with an explosion in a confined space.
Exclusion Criteria:
- Likely to die within 48 hours based upon severity of injury.
- Less than 18 years old.
- Burned patient transferred to our facility already on mechanical ventilation for more than 48 hours.
- Patient already on antibiotics for another reason.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: bronchoscopy intervention group
Group undergoing scheduled bronchoscopy.
|
Scheduled bronchoscopy.
|
NO_INTERVENTION: Control group
Standard treatment without scheduled bronchoscopy.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
All Cause Mortality
Time Frame: until death or discharge from hospital, data reviewed every 6 months
|
Bronchoscopy group deaths n=0.
Control group deaths n=1.
|
until death or discharge from hospital, data reviewed every 6 months
|
Respiratory Associated Mortality
Time Frame: until death or discharge from hospital, data reviewed every 6 months
|
Bronchoscopy group deaths n=0.
Control group deaths n=1.
|
until death or discharge from hospital, data reviewed every 6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of Pneumonia
Time Frame: until discharge from the hospital, data reviewed every 6 months
|
Bronchoscopy group- 4/13 (31%) Control group- 6/15 (40%)
|
until discharge from the hospital, data reviewed every 6 months
|
Length of Mechanical Ventilation
Time Frame: until discharge from hospital, data reviewed every 6 months
|
Days of mechanical ventilation (bronchoscopy 5.1 days, 95% CI +/- 3.6 days versus control 6.7 days, 95% CI +/- 6.3 days, p = 0.7).
|
until discharge from hospital, data reviewed every 6 months
|
Length of ICU Stay
Time Frame: until discharge from hospital, data reviewed every 6 months
|
Number of ICU days (bronchoscopy 10 days, 95% CI +/- 10 days versus control 18 days, 95% CI +/- 12 days, p = 0.4).
|
until discharge from hospital, data reviewed every 6 months
|
Length of Hospital Stay
Time Frame: until discharge from hospital, data reviewed every 6 months
|
Number of hospital days (bronchoscopy 21 days, 95% CI +/- 12 days versus control 26 days, 95% CI +/- 12 days, p = 0.5).
|
until discharge from hospital, data reviewed every 6 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: John A Carr, MD, Hurley Medical Center
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- HMC0001
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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