- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01501227
Ventilator Associated Pneumonia in Taper Guard Versus Normal Tube in ICU Patients
Comparison of the Incidence of Ventilator Associated Pneumonia in Patients Intubated With the Taper Guard Endotracheal Tube Versus a Normal Endotracheal Tube
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Methodology This will be a prospective randomized trial with 2 treatment groups with 100 patients in each arm. The control group ( Group C) will be intubated with our conventional endotracheal tubes and the test group ( Group T) will be intubated with the special Taper guard tubes with subglottic suctioning and snug fit facilities.
All adult patients ( > 18 years of age) admitted into the Intensive Care Unit who are likely to receive more than 72 hours of ventilation will be admitted into the trial. The trial has been cleared by the Hospital Ethics and informed consent will be obtained from the patient's next of kin.
All patients will have their demographic data collected, the primary reason for ICU admission, the APACHE 2 scores, presence of infection at admission, antibiotic use and whether they have risk factors for VAP ( previous surgery, trauma, antibiotics usage, reflux disease and use of stress ulcer prophylaxis, decreased immune status ) The following guidelines modified from the American Thoracic Society 2005 will be used as the basis for diagnosing Ventilator Associated Pneumonia.
Guideline for Diagnosis of Ventilator Associated Pneumonia (VAP)2
- Patient ventilated for more than 48 hours.
- Suspicion of ventilation associated pneumonia
- Presence of a new or progressive infiltrate on chest radiograph.
At least 2 of the following:
- Fever, defined as an oral temperature greater than 38 degree C, a tympanic temperature greater than 38.5 degree C or a rectal /core temperature greater than 39 degree C OR hypothermia, defined as a rectal/core body temperature of less than 35 degree C.
- Elevated total peripheral WBC count (greater than 12000/mm3) or greater than 15% bands regardless of total peripheral WBC count; or leucopenia with total peripheral WBC less than 4500/mm3 (caused by the infection)
- New onset of purulent sputum production or other respiratory secretions (e.g. tracheal secretions), or a change in the character of sputum or tracheal secretions
- Worsening hypoxaemia with reduction in PaO2/ FiO2 greater or equal to 15%
In addition all patients will have aspirants from the oral cavity (control group) or subglottic region (group T) and the lungs ( both group C and group T) sent on alternate days for bacterial culture. All tubes will be inflated to a sealing pressure of no leak or up to 20-25 cm H2O whichever is the lower.
The sample size has been estimated based on the incidence of ventilation-associated pneumonia (VAP) which is the primary outcome measure from other studies1,2. Based on a VAP incidence of 20% and 6% in each group, 1:1 ratio, 80% power and significance value of 0.05, the number required in each group will be 89. Adding 10% for loss to follow-up, the number needed in each group will be 100 giving a total of 200 The assignment of each patient to the study will be randomized according to computer generated random numbers by the statistician who will not be a party in the ongoing clinical part of the research. In addition she will provide the allocation sequencing via an opaque envelope when a suitable patient has been identified for the assignment of the patient to the 2 groups when informed consent has been obtained. The person who intubates the patient with the endotracheal tube will use the tube that has been allocated according to the written instruction inside the now opened opaque envelope.
Patient and the clinical researchers managing the patient cannot be blinded as there are obvious differences between the 2 types of endotracheal tubes. However the assessor that will determine the presence or absence of the soft signs of ventilator associated pneumonia will be blinded to the type of tubes used. The Radiologist who reads the Chest Xrays will not be privy to the type of tubes used and the Microbiologist determining the significance of the bacteria identified in the oral/subglottic secretions and the tracheal secretions will not be aware of the endotracheal tubes used.
The main outcome measure will be the incidence of ventilator associated pneumonia on each day the patient is ventilated. The secondary outcomes will be the length of ventilation, the duration of intensive care stay, the duration of hospital stay (pre-intensive care, post-intensive care) and the incidence of mortality of the 2 groups.
Statistics Categorical variables will be analysed using Chi square test while continuous variables will be analysed using ANOVA. Intention to treat analysis will be used. Analysis will be carried out using the SPSS version 15.0 software. All statistical tests will be carried out using a significance level of 0.05.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Yoo-Kuen Chan, FFARCSI
- Phone Number: +6012-2937163
- Email: chanyk@ummc.edu.my
Study Contact Backup
- Name: Vineya RAI, MAnesth; EDIC
- Phone Number: +60122157175
- Email: vineya74@yahoo.com
Study Locations
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Kuala Lumpur, Malaysia, 50603
- University of Malaya Medical Centre
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Contact:
- Yoo-Kuen Chan, FFARCSI
- Phone Number: +6012-2937163
- Email: chanyk@ummc.edu.my
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Contact:
- Vineya Rai, MBBS;MAnesth;EDIC
- Phone Number: +60122157175
- Email: vineya74@yahoo.com
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Principal Investigator:
- Yoo-Kuen Chan, FFARCSI
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Sub-Investigator:
- Vineya Rai, MAnesth;EDIC
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Sub-Investigator:
- Mohd Shahnaz Hassan, MBBS;MAnesth
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Sub-Investigator:
- Suresh Venogobal, MAnesth, FANZCA
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Sub-Investigator:
- Kang-Kwong Wong, MBBS;MAnesth
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Sub-Investigator:
- Mohd Yasim Yusof, MBBS; MMicrobiology
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Sub-Investigator:
- Foong-Ming Moy, BSc, MScMMedScPH, PhD
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Sub-Investigator:
- Nur Adura Yaakup, MBBS;MRad
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All adult patients above 18 years old admitted into the Intensive Care unit and who is to be intubated and likely to receive more than 72 hours of ventilation would be admitted into the trial
Exclusion Criteria:
- presence of cavitary lung disease based on chest x-ray findings,
- primary lung cancer or another metastatic malignancy to the lungs, or known or suspected viral or fungal etiology,
- pneumocystis carinii pneumonia,
- legionella OR Mycoplasma pneumonia or active tuberculosis.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Taper Guard Endotracheal Tube
Patients in the test group will be intubated with the Taper Guard Endotracheal Tube.
The incidence of VAP, the length of ventilation, the length of intensive care stay, the length of hospital stay and the mortality rate will be monitored.
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comparison of two different endotracheal tubes
Other Names:
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Sham Comparator: conventional endotracheal tube
Patients in the placebo comparator group will be intubated with the conventional Endotracheal Tube.
The incidence of VAP, the length of ventilation, the length of intensive care stay, the length of hospital stay and the mortality rate will be monitored.
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Sham Comparator
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
incidence of ventilator associated pneumonia(VAP)
Time Frame: 72 hours after ventilation initiated to onset of pneumonia
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the incidence of VAP in patients intubated with the Taper guard tube is compared with the incidence of VAP in patients intubated with the ordinary tube.
The criteria for diagnosing VAP is from the American Thoracic Society 2005 guidelines for VAP diagnosis.
The assessor for VAP diagnosis is blinded
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72 hours after ventilation initiated to onset of pneumonia
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of days on the ventilator by the time patient is discharged from ICU or hospital or at time of death
Time Frame: participants will be followed for the duration of ventilation, an expected average of 2 weeks
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The number of days patient is on the ventilator will be monitored between the 2 groups
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participants will be followed for the duration of ventilation, an expected average of 2 weeks
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The total number of days spent in the intensive care unit by the time of discharge from hospital or death
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 3 weeks
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The length of stay in the intensive care unit will be monitored between the 2 groups
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participants will be followed for the duration of hospital stay, an expected average of 3 weeks
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The number of days spent in the hospital by the time of discharge or death
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 4 weeks
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The length of stay in the hospital will be monitored for the 2 groups
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participants will be followed for the duration of hospital stay, an expected average of 4 weeks
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number of deaths in each arm
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 4 weeks
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the rate of mortality between the 2 groups will be monitored
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participants will be followed for the duration of hospital stay, an expected average of 4 weeks
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Yoo-Kuen Chan, FFARCSI, Department of Anesthesiology, Faculty of Medicine, University of Malaya
- Study Director: Vineya Rai, MAnesth; EDIC, Department of Anesthesiology, Faculty of Medicine, University of Malaya
- Study Director: Mohd Shahnaz Hassan, MBBS;MAnesth, Department of Anesthesiology, Faculty of Medicine, University of Malaya
- Study Director: Suresh Venogobal, MBBS; FANZCA, Department of Anesthesiology, Faculty of Medicine, University of Malaya
- Study Director: Kang-Kwong Wong, MBBS;MAnesth, Department of Anesthesiology, Faculty of Medicine, University of Malaya
- Study Director: Mohd Yasim Yusof, MBBS;MSc Microbiology, Department of Microbiology, Faculty of Medicine, University of Malaya
- Study Director: Foong-Ming Moy, BSc, MSc, MMedSc PH, PhD, Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya.
- Study Director: Nur Adura Yaakup, MBBS, MRad, Department of Biomedical Imaging, Faculty of Medicine, University of Malaya
Publications and helpful links
General Publications
- Lorente L, Lecuona M, Jimenez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007 Dec 1;176(11):1079-83. doi: 10.1164/rccm.200705-761OC. Epub 2007 Sep 13.
- American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416. doi: 10.1164/rccm.200405-644ST. No abstract available.
- Bo H, He L, Qu J. [Influence of the subglottic secretion drainage on the morbidity of ventilator associated pneumonia in mechanically ventilated patients]. Zhonghua Jie He He Hu Xi Za Zhi. 2000 Aug;23(8):472-4. Chinese.
- Smulders K, van der Hoeven H, Weers-Pothoff I, Vandenbroucke-Grauls C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest. 2002 Mar;121(3):858-62. doi: 10.1378/chest.121.3.858.
- Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heyland DK. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med. 2011 Aug;39(8):1985-91. doi: 10.1097/CCM.0b013e318218a4d9.
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
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
- MEC 859.8
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