- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01038531
Biomarkers of Lung Injury With Low Tidal Volume Ventilation Compared With Airway Pressure Release Ventilation
December 16, 2016 updated by: Allan J. Walkey, Boston Medical Center
Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) represent a spectrum of clinical syndromes of rapid respiratory system deterioration that are associated with both pulmonary and systemic illness.
These syndromes are associated with 30-40% mortality with our current standard of care and are responsible for approximately 75,000 deaths in the US yearly.
Current evidence-based care of ALI consists of a strategy of mechanical ventilation utilizing low lung volumes (ARDSNet ventilation) intended to limit further stretch-induced lung injury exacerbated by the ventilator.
However, this strategy has been shown to be associated with increased lung injury in a subset of patients and still is associated with about a 30% mortality rate.
Airway pressure release ventilation (APRV) is a different, non-experimental strategy of mechanical ventilation currently in routine clinical use.
APRV is a pressure-cycled ventilator mode that allows a patient a greater degree of autonomy in controlling his or her breathing pattern than ARDSNet ventilation.
Use of APRV has been associated with better oxygenation, less sedative usage, and less ventilator-associated pneumonia in small studies compared with other ventilator modes.
However, debate exists over whether APRV might result in decreased or increased ventilator-associated lung injury when compared with ARDSNet ventilation.
We intend to implement a randomized, cross over study looking at biomarkers of lung injury in patients with acute lung injury during ventilation with APRV and using the ARDSNet protocol.
Our hypothesis is that airway pressure release ventilation is associated with lower levels of lung injury biomarkers than ARDSNet ventilation.
Study Overview
Status
Terminated
Intervention / Treatment
Detailed Description
Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) represent a spectrum of clinical syndromes of rapid respiratory system deterioration that are associated with both pulmonary and systemic illness.
These syndromes are associated with 30-40% mortality with our current standard of care and are responsible for approximately 75,000 deaths in the US yearly.
The current evidence-based care consists of a strategy of mechanical ventilation utilizing low lung volumes (ARDSNet ventilation) intended to limit further lung injury from overstretch of the lung induced by the ventilator.
However, this strategy has been shown to be associated with continued lung injury in some studies and still is associated with about a 30% mortality rate.
Airway pressure release ventilation (APRV) is a different, nonexperimental strategy of mechanical ventilation currently in routine clinical use.
APRV allows a patient a greater degree of autonomy in controlling his/her breathing while achieving a higher mean airway pressure (at similar plateau pressures) than that typically achieved with ARDSNet.
APRV has been associated with less ventilator-associated pneumonia, better oxygenation, and less sedative usage in small studies when compared with other methods of ventilation.
However, debate exists over net effects of APRV with regard to ventilator-associated lung injury.
Additionally, we recently completed a study showing that APRV was associated with lower ventilator associated pneumonia (VAP) rates, but this benefit did not appear to be mediated by sedation differences.
We hypothesized that the VAP benefits might be mediated by greater lung recruitment and possibly less ventilator-induced lung injury with APRV.
We propose a randomized, crossover study looking at biomarkers of lung injury in patients with acute lung injury ventilated with APRV and ARDSNet.
Our hypothesis is that airway pressure release ventilation is associated with lower levels of lung injury biomarkers than ARDSNet ventilation.
Study Type
Interventional
Enrollment (Actual)
3
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Massachusetts
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Boston, Massachusetts, United States, 02118
- Boston Medical Center
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Age > or equal to 18.
- On mechanical ventilation using a volume-controlled mode.
- Admitted to Boston Medical Center Surgical, Medical, or Coronary Intensive Care Unit.
- Meets American-European Consensus Criteria for Acute Lung Injury (ALI) or Acute Respiratory Distress Syndrome.
- Required mechanical ventilator for less than 14 days.
- Met ARDS or ALI criteria for less than 7 days prior to enrollment.
- Assent of primary care team
Exclusion Criteria:
- Do not resuscitate order.
- Increased intracranial pressure.
- Pregnancy (urine pregnancy test for all women of child-bearing age).
- Planned transport out of ICU during planned study protocol.
- Coagulopathy (INR>2.0 or PTT >50).
- Severe thrombocytopenia (platelets <20,000).
- History of obstructive lung disease (asthma and/or COPD).
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: low-tidal-volume ventilation
Goal tidal volume is 6 cc/kg ideal body weight.
|
goal tidal volume of 6 cc/kg ideal body weight
|
Experimental: APRV
APRV allows spontaneous breathing.
|
APRV is a time cycled, inverse-ratio, pressure controlled strategy that allows spontaneous breathing through the respiratory cycle.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The study will be powered to detect a decrease in plasma IL-6 levels (pg/ml) from ARDSNet to APRV
Time Frame: 6 hours
|
6 hours
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Changes in dose of sedation medications
Time Frame: 6 hours
|
6 hours
|
Riker score
Time Frame: 6 hours
|
6 hours
|
Lung mechanics
Time Frame: 6 hours
|
6 hours
|
Oxygenation with APRV versus ARDSNet
Time Frame: 6 hours
|
6 hours
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: George O'Connor, MD, Boston University Medical College
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
July 1, 2010
Primary Completion (Actual)
June 1, 2016
Study Completion (Actual)
September 1, 2016
Study Registration Dates
First Submitted
December 22, 2009
First Submitted That Met QC Criteria
December 23, 2009
First Posted (Estimate)
December 24, 2009
Study Record Updates
Last Update Posted (Estimate)
December 19, 2016
Last Update Submitted That Met QC Criteria
December 16, 2016
Last Verified
December 1, 2016
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- H-28944
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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