Initial Ventilation Strategy for Adult Immunocompromised Patients With Acute Respiratory Failure

VENIM is a multicenter, open-label, parallel-group randomized controlled trial of studying the initial ventilation strategy for adult immunocompromised patients with acute respiratory failure.

Study Overview

• Status: Unknown
• Conditions: Acute Respiratory Failure; Immunocompromised Patients
• Intervention / Treatment: Procedure: Noninvasive mechanical ventilation; Procedure: Invasive mechanical ventilation

Detailed Description

The VENIM is a multicenter randomized controlled trial (RCT) comparing the effects of NIV compared with IMV in adult immunocompromised patients with moderate to severe acute respiratory failure (ARF). Patients who meet the indications for both ventilatory supports will be included. The intervention will consist of randomly allocation, treatment with NIV or IMV, concomitant medication. Primary outcome is 30-day hospital mortality. Secondary outcomes include in-hospital mortality, length of stay in hospital, improvement of oxygenation, nosocomial infections, seven-day organ failure, adverse events of intervention, et al. Subgroups with different disease severity, causes of immunodeficiency and types of ARF will also be analyzed.

• Study Type: Interventional
• Enrollment (Anticipated): 238
• Phase: Not Applicable

Contacts and Locations

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Adult (18 years old ≤ age ≤ 80 years old) immunocompromised patients admitted to hospital with moderate to severe ARF diagnosed within the last 72 hours, which meets the indications for ventilatory support.

• Patients are considered as moderate to severe ARF when the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) is between 85 and 170 while the patient is breathing oxygen through a Venturi mask, or clinically diagnosed as the following:

  1. 30 mmHg < PaO2 < 50 mmHg on room air;
  2. Clinical evidence of respiratory distress (intercostal recession, polypnea >35/min or dyspnea at rest).

• Patients are considered as immunocompromised when clinically diagnosed as at least one of the following:

  1. HIV infection;
  2. Hematologic malignancy or solid tumor under chemotherapy;
  3. Solid organ or stem cell transplant;
  4. Long-term (>30 days) or high dose steroids (>1 mg/kg/d prednisone equivalent) usage and/or any other immunosuppressive drugs;
  5. Neutropenia (defined as a neutrocyte count of < 0.50×109/L) showing for at least 48 hours

Exclusion Criteria:

• Age<18 or >80 years old;
• Partial pressure of arterial carbon dioxide (PaCO2) > 50 mmHg or arterial pH < 7.20;
• PaO2/FiO2 >170 or PaO2/FiO2< 85;
• Patients have been treated with NIV or IMV within 30 days.
• NIV is contraindicated or IMV is definitely indicated, including PaO2/FiO2< 85, respiratory arrest, hemodynamic instability, inability to fit the face mask, pneumothorax, vomiting, development of airway bleeding, inability to protect the airway, or copious respiratory secretions;
• Comorbided with other severe diseases, including New York Heart Association functional class ≥ II, valvular heart disease, dilated cardiomyopathy, cardiogenic pulmonary edema, implanted cardiac pacemaker, unstable angina, myocardial infarction, or cardiac surgery within the previous 3 months; systolic arterial pressure <90 mmHg after optimal fluid therapy; history of chronic obstructive pulmonary disease (COPD) or asthma; impaired consciousness (Glasgow Coma Scale score <13); postoperative acute respiratory failure; pregnancy or breastfeeding;
• Lack of consent, do-not-intubate decision, and any other situations where obvious bias are expected

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Noninvasive mechanical ventilation; Patients in this group will receive Noninvasive mechanical ventilation as the initial mechanical ventilation (MV) strategy, irrespective of whether Invasive mechanical ventilation is used later during the following treatment.	Procedure: Noninvasive mechanical ventilation; Noninvasive mechanical ventilation will be delivered to the patient through a mask. The mask will be adjusted and connected to a ventilation system.
Active Comparator: Invasive mechanical ventilation; Patients in this group will receive Invasive mechanical ventilation as the initial MV strategy, irrespective of whether Noninvasive mechanical ventilation is used later during the following treatment.	Procedure: Invasive mechanical ventilation; Invasive mechanical ventilation will be initially performed by using the volume controlled mode, and could be adjusted to pressure controlled mode or other modes based on clinical situation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
30-day all-cause mortality	the 30th day after patient inclusion in the study

Secondary Outcome Measures

Outcome Measure	Time Frame
In-hospital mortality	through study study completion, an average of 2 years
Length of stay in hospital	through study study completion, an average of 2 years
Length of mechanical ventilation	through study study completion, an average of 2 years
Nosocomial infections	through study study completion, an average of 2 years

Collaborators and Investigators

• Sponsor: Peking Union Medical College Hospital
• Collaborators: The First Affiliated Hospital with Nanjing Medical University; National Natural Science Foundation of China; The First Affiliated Hospital of Anhui Medical University; The Second Hospital of Hebei Medical University; First Affiliated Hospital, Sun Yat-Sen University; Ministry of Health, China; The First Affiliated Hospital of Zhengzhou University; Tianjin Medical University General Hospital; Renmin Hospital of Wuhan University; The Affiliated Hospital Of Guizhou Medical University; The First Affiliated Hospital of Kunming Medical College; General Hospital of Ningxia Medical University; The Second Affiliated Hospital of Harbin Medical University; Second Xiangya Hospital of Central South University; Cangzhou Central Hospital; Fujian Provincial Hospital; The Affiliated Hospital of Inner Mongolia Medical University; Handan First Hospital
• Investigators: Study Chair: Yi Li, M.D., PUMC hospital,Chinese Academy of Medical Sciences

Publications and helpful links

General Publications

• Wang T, Liu G, He K, Lu X, Liang X, Wang M, Zhu R, Li Z, Chen F, Ke J, Lin Q, Qian C, Li B, Wei J, Lv J, Li L, Gao Y, Wu G, Yu X, Wei W, Deng Y, Wang F, Zhang H, Zheng Y, Zhan H, Liao J, Tian Y, Yao D, Zhang J, Chen X, Yang L, Wu J, Chai Y, Shou S, Yu M, Xiang X, Zhang D, Chen F, Xie X, Li Y, Wang B, Zhang W, Miao Y, Eddleston M, He J, Ma Y, Xu S, Li Y, Zhu H, Yu X. The efficacy of initial ventilation strategy for adult immunocompromised patients with severe acute hypoxemic respiratory failure: study protocol for a multicentre randomized controlled trial (VENIM). BMC Pulm Med. 2017 Sep 20;17(1):127. doi: 10.1186/s12890-017-0467-6.

Study record dates

Study Major Dates

• Study Start: December 1, 2016
• Primary Completion (Anticipated): September 1, 2018
• Study Completion (Anticipated): December 1, 2018

Study Registration Dates

• First Submitted: November 25, 2016
• First Submitted That Met QC Criteria: December 2, 2016
• First Posted (Estimate): December 6, 2016

Study Record Updates

• Last Update Posted (Estimate): December 6, 2016
• Last Update Submitted That Met QC Criteria: December 2, 2016
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Keywords: Invasive mechanical ventilation; Noninvasive mechanical ventilation
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Respiration Disorders; Lung Diseases; Respiratory Insufficiency; Respiratory Distress Syndrome
• Other Study ID Numbers: VENIM

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED