- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02877498
A Study to Compare Adaptive Support Ventilation vs. Volume Controlled Ventilation for Management of Respiratory Failure in Patients With Neuroparalytic Snake Envenomation (ASV vs VCV in)
Study Overview
Status
Intervention / Treatment
Detailed Description
Snake envenoming is a common medical emergency encountered in the tropical countries, and an estimated 35,000 -50,000 people die of snakebite every year in India. The bites of elapid snakes cause predominantly neurotoxicity, which manifests as ocular and bulbar paralysis, and paralysis of the muscles of respiration, with resultant respiratory failure. The management of these patients includes ventilatory support and administration of snake anti-venom. Respiratory failure requiring mechanical ventilatory support is a frequent cause of admission to the intensive care unit (ICU). Mechanical ventilation is a life-saving intervention, and once there is improvement of the underlying indication, it can be withdrawn abruptly in the majority. However, approximately 20-30% of patients still require gradual discontinuation (ie, weaning). This process is not only difficult in patients with chronic respiratory diseases and acute neuromuscular disorders, such as neurotoxic snake bite, but is also associated with important complications, such as nosocomial pneumonia, prolonged ICU stay, and even mortality, especially in those with persistent weaning failure.
Adaptive support ventilation (ASV) is a closed-loop ventilation mode designed to provide a user-set minimum minute ventilation in intubated patients, either actively breathing or passively ventilated. ASV automatically selects a target ventilatory pattern based on user inputs [patient's predicted body weight (PBW), minimum minute volume, and pressure limit] and respiratory mechanics data from the ventilator monitoring system (respiratory system expiratory time constant and dynamic compliance). The algorithm selects ventilatory parameters so as to minimize total work of inspiration, and the ventilator continuously adapts to match changes in respiratory mechanics by using automatic controls for level of inspiratory pressure above positive end-expiratory pressure (PEEP), frequency, and inspiratory time of ventilator-initiated breaths.
In most studies, ASV has been used only in the weaning phase, and patients were ventilated with conventional modes until weaning. However recent studies suggest its role in primary ventilation in the initial phase of respiratory failure. Previous use of ASV in patients with acute respiratory distress syndrome has been described from our center and the use of ASV was equally efficacious to conventional mode of ventilation (volume control). In another study the use of ASV in comparison to pressure control ventilation in patients with acute respiratory failure reduced the weaning duration and total duration of mechanical ventilation. Because ASV can be used from intubation to extubation, it may also offer some advantages before the weaning phase in patients with respiratory failure. Therefore, we hypothesize that ASV may shorten the total mechanical ventilation (MV) duration, weaning duration, and increase the weaning success rates when compared with conventional ventilation in the management of patients with neuroparalytic snake envenomation.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Chandigarh, India, 160012
- Respiratory ICU, Post Graduate Institue of Medical Education and Research
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Need for invasive mechanical ventilation for management of respiratory failure
- age group of 12 to 90 years
- ability to provide informed consent to participate in the study
Exclusion Criteria:
- Cardiorespiratory arrest requiring cardiopulmonary resuscitation
- pregnancy
- failure to provide informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: TRIPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Adaptive support ventilation
adaptive support ventilation mode during invasive mechanical ventilation
|
Adaptive support ventilation during invasive mechanical ventilation
|
ACTIVE_COMPARATOR: Volume controlled ventilation
Volume controlled ventilation during invasive mechanical ventilation
|
Volume controlled ventilation during invasive mechanical ventilation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Liberation from mechanical ventilation
Time Frame: 28 days after discharge
|
Liberation from mechanical ventilation (defined as time [in hours] between intubation to extubation for at least six hours)
|
28 days after discharge
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of ventilator associated pneumonia
Time Frame: 28 days after discharge
|
Ventilator associated pneumonia
|
28 days after discharge
|
Post extubation respiratory failure
Time Frame: 28 days after discharge
|
Post extubation respiratory failure (defined as need for either NIV or reintubation)
|
28 days after discharge
|
In hospital mortality
Time Frame: 28 days after discharge
|
Death during hospital stay
|
28 days after discharge
|
ICU and hospital length of stay
Time Frame: 28 days after discharge
|
Intensive care unit and hospital length of stay
|
28 days after discharge
|
Collaborators and Investigators
Investigators
- Study Director: Ritesh Agarwal, MD,DM, PGIMER,Chandigarh
Study record dates
Study Major Dates
Study Start (ACTUAL)
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 (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NK/2194/Study/1241(168)
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