A Randomised Pilot Multiple Centre Trial of Conservative Versus Liberal Oxygenation Targets in Critically Ill Children

Conservative Versus Liberal Oxygenation Targets in Critically Ill Children

Sponsors

Lead sponsor: Great Ormond Street Hospital for Children NHS Foundation Trust

Collaborator: Intensive Care National Audit & Research Centre
University of Southampton
St Mary's Hospital, London
University Hospital Southampton NHS Foundation Trust
University College, London

Source Great Ormond Street Hospital for Children NHS Foundation Trust
Brief Summary

A feasibility study to determine if it is possible to perform a safe, adequately powered, and affordable multi-centre study in critically ill children comparing current practice of liberal targets for systemic oxygen levels with more conservative targets.

Detailed Description

Around 19,000 critically ill children are admitted to paediatric intensive care units (PICU) each year in the UK. A large number of these children need breathing support, and this is usually provided through an invasive machine called a 'ventilator'. Clinicians make decisions for treatment based on how much oxygen their patient has in their blood (this is called oxygen saturation or oxygenation) and currently the amount of oxygen critically ill children need is not fully understood. This means that some clinicians use a lower oxygen saturation target, and others, a higher target. This may be problematic as research in neonates (babies) and adults has shown that oxygen saturation levels can influence a patient's chance of survival, how long they stay in hospital and healthcare costs.

Response to oxygen is different in babies, children and adults. This means that the results from the neonatal and adult research are unlikely to be valid or applicable in children due to age-related differences. Urgent high quality clinical evidence is therefore needed to inform on the best targets of oxygenation during critical illness in children.

As large clinical trials are expensive to conduct, it is important to demonstrate that a large-scale trial can be done and that the different components of a trial can all work together. Therefore, the Oxy-PICU study is a 'pilot randomised clinical trial' (a smaller version of the trial we would like to conduct) and will test the feasibility and safety of conducting a large scale trial comparing a restrictive oxygen saturation target (88-92%) with a more liberal oxygen saturation target (>94%). Oxy-PICU will also collect blood and urine samples to allow for in depth study of the biology of the different oxygenation targets.

The pilot trial will take place at three PICUs (two in London and one in Southampton) and aims to include between 115-125 eligible children over six months. Given the emergency nature of these children and the need to provide immediate care, informed consent will be sought after the children are entered into the study (this is known as deferred consent).

Overall Status Completed
Start Date March 4, 2017
Completion Date July 1, 2017
Primary Completion Date June 25, 2017
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
Number of eligible patients recruited per site per month Baseline
Secondary Outcome
Measure Time Frame
Proportion of parents/legal representatives refusing deferred consent Through study completion, an average of 24 hours
Proportion of eligible patients randomised Baseline
Distribution of time to randomisation Baseline
Proportion of systemic oxygen saturations within the target range in each group Through study completion, an average of 72 hours
Proportion of patients in each arm requiring other treatments influencing tissue oxygen delivery (blood transfusion, inotropic support) Through study completion, an average of 72 hours
Length of ventilation - proportion of randomised patients with outcome available in each group Through study completion, an average of 2 days
Length of ventilation - mean (standard deviation) in each group Through study completion, an average of 2 days
Length of ventilation - median and quartiles in each group. Through study completion, an average of 2 days
Observed adverse events 28 days
Time taken for data collection and entry 28 days
Measurement of ischemia-modified albumin (plasma) 72 hours
Measurement of malondialdehyde (plasma) 72 hours
Measurement of total antioxidant status (plasma) 72 hours
Length of PICU stay - proportion of randomised patients with outcome available in each group Through study completion, an average of 2 days
Length of PICU stay - mean (standard deviation) in each group. Through study completion, an average of 2 days
Length of PICU stay - median and quartiles in each group. Through study completion, an average of 2 days
Hospital mortality - proportion of randomised patients with outcome available in each group Through study completion, an average of 2 days
Hospital mortality - number (percentage) in each group. Through study completion, an average of 2 days
PICU mortality - proportion of randomised patients with outcome available in each group Through study completion, an average of 2 days
PICU mortality - number (percentage) in each group. Through study completion, an average of 2 days
Days of organ specific support - proportion of randomised patients with outcome available in each group Through study completion, an average of 2 days
Days of organ specific support - mean (standard deviation) in each group Through study completion, an average of 2 days
Days of organ specific support - median and quartiles in each group Through study completion, an average of 2 days
Measurement of hypoxia-inducible factor-1 alpha mRNA expression (leukocytes) 72 hours
Enrollment 120
Condition
Intervention

Intervention type: Procedure

Intervention name: Conservative oxygenation target

Description: Participants allocated to the conservative oxygenation target group will receive supplemental oxygen and ventilator settings at the discretion of the treating clinical team with the aim of peripheral oxygen saturations remaining 88-92% (inclusive).

Arm group label: Conservative oxygenation target

Intervention type: Procedure

Intervention name: Liberal oxygenation target

Description: Participants allocated to the liberal oxygenation target group will receive supplemental oxygen and ventilator settings at the discretion of the treating clinical team with the aim of peripheral oxygen saturations remaining >94%.

Arm group label: Liberal oxygenation target

Eligibility

Criteria:

Inclusion Criteria:

- less than 16 years and > 38 weeks corrected gestational age

- receiving supplemental oxygen for abnormal gas exchange

- emergency admission accepted to a participating paediatric intensive care unit (PICU) requiring mechanical ventilation within first 6 hours of face-to-face contact with PICU staff or transport team

Exclusion Criteria:

- recruited to Oxy-PICU in a previous admission

- brain pathology/injury as a primary reason for admission (e.g traumatic brain injury, post-cardiac arrest, stroke, convulsive status epilepticus without aspiration)

- known pulmonary hypertension

- known or suspected sickle cell disease

- known or suspected uncorrected congenital cardiac disease

- End-of-life care plan in place with limitation of resuscitation

- not expected to survive PICU admission

- receiving long-term mechanical ventilation prior to this admission (non-invasive ventilation or invasive ventilation)

Gender: All

Minimum age: 39 Weeks

Maximum age: 15 Years

Healthy volunteers: No

Location
facility
Great Ormond Street Hospital for Children | London, United Kingdom
St Mary's Hospital | London, United Kingdom
Southampton General Hospital | Southampton, United Kingdom
Location Countries

United Kingdom

Verification Date

February 2018

Responsible Party

Responsible party type: Sponsor

Has Expanded Access No
Condition Browse
Number Of Arms 2
Arm Group

Arm group label: Conservative oxygenation target

Arm group type: Experimental

Description: Children in the conservative oxygenation target group receive treatment targeting oxygen saturation values of 88-92%.

Arm group label: Liberal oxygenation target

Arm group type: Active Comparator

Description: Children in the liberal oxygenation target group receive treatment targeting oxygen saturation values of >94%.

Acronym Oxy-PICU
Study Design Info

Allocation: Randomized

Intervention model: Parallel Assignment

Primary purpose: Treatment

Masking: None (Open Label)

Source: ClinicalTrials.gov