- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03180203
Postoperative INTELLiVENT-ASV Ventilation (POSITiVE)
The Full Closed Loop Ventilation Mode INTELLiVENT-ASV: User-friendly and Effective Mechanical Ventilation in High Risk Postoperative Patient on the Intensive Care Unit
Study Overview
Status
Intervention / Treatment
Detailed Description
Recently, Hamilton Medical has introduced the new mechanical ventilation mode "INTELLiVENT-ASV". This is a fully closed ventilation mode that can automatically adjust the ventilation settings based on the measured End tidal CO2 (ETCO2) and the measured saturation (SpO2) in both passive and active ventilated patients. Current literature has shown that this mode is safe to use in patients admitted on the intensive care unit. A pilot study in the Catharina Hospital Eindhoven confirmed that in postoperative low risk patients on the intensive care unit INTELLiVENT-ASV is safe. Compared to continuous mandatory or pressure controlled ventilation with pressure support (conventional mechanical ventilation), INTELLiVENT-ASV is even as effective as conventional mechanical ventilation, with a significantly reduced number of interactions with the ventilator. However, available research about the effectiveness of INTELLiVENT-ASV in postoperative high risk patients is lacking. Also the knowledge about the user-friendliness of the above modes of mechanical ventilation for the users is lacking.
This is a prospective randomized study with a control group and a intervention group of postoperative high risk patients. Through randomization will be determined whether the participant, after surgery, will be mechanically ventilated with INTELLiVENT-ASV and Quickwean or with conventional mechanical ventilation.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Noord-Brabant
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Eindhoven, Noord-Brabant, Netherlands, 5623 EJ
- Catharina hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age above 18 years of age.
- Informed consent.
- Body mass index of <35 kg/m2.
- Mechanical ventilation after elective cardiothoracic surgery.
- Admission of the patient after surgery is on the high care unit of the intensive care ward for postoperative mechanical ventilation.
Exclusion Criteria:
- Withdrawal of consent
- Medical history of a pneumonectomy or lobectomy.
- The patient wit acute respiratory distress syndrome after surgery.
- The patient with a medical history of COPD Gold 3 or 4.
- The patient is participating in another postoperative study performed on the intensive care.
- The patient is, preoperatively determined, eligible for a fast-track postoperative treatment program on the Post Anesthesia Care Unit.
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 |
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Experimental: INTELLiVENT-ASV
INTELLiVENT-ASV is a full closed-loop ventilation mode,available on the mechanical ventilator S1 of Hamilton.
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After ICU admission:
Settings SBT are MV% 25%,PEEP 5cmH2O.SBT automatically stops if respiratory rate >35b/min or increases >100% since start of SBT, FiO2 >50%, PeTCO2 increases >8mmHg. Extubation criteria: Leakage <50ml/hr,hemodynamically stable, awake with enough muscle strength and successful SBT >10min. If during mechanical ventilation the ICU care providers decide that it is necessary for the treatment, they may switch to another ventilation mode or extubate without a SBT. |
Active Comparator: Conventional modes
Volume controlled continuous mandatory ventilation (CMV) mode with pressure support mode on the Hamilton S1 Device.
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After ICU admission: The first three hours: only ventilation with CMV or PS. If required care providers may change the mode to adaptive support ventilation. After three hours: manual SBT is required if >10min PS<11cmH2O,PEEP<9cmH2O,FiO2<41%. Settings SBT are PS 5cmH2O, PEEP 5cmH2O, FiO2 30%. SBT must be stopped if respiratory rate >35b/min or increases >100% since the start of SBT, saturation <92% or the PeTCO2 increases >8mmHg. Extubation criteria: Leakage <50ml/hr,hemodynamically stable, awake with enough muscle strength and successful SBT >10min. If during mechanical ventilation the ICU care providers decide that it is necessary for the treatment, they may switch to another ventilation mode or extubate without a SBT. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage (%) of mechanical ventilation time in an optimal, acceptable or unacceptable ventilation zone.
Time Frame: During the first 3 hours, since admission on the ICU with the start of the intervention ventilation mode.
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During the first 3 hours, since admission on the ICU with the start of the intervention ventilation mode.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The percentage (%) of successful extubations.
Time Frame: During the first 24, 48 and 72 hours after extubation
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A successful extubation is an extubation without a new intubation or the use of non-invasive ventilation within 24, 48 or 72 hours.
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During the first 24, 48 and 72 hours after extubation
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Postoperative weaning time
Time Frame: 72 hours
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The time from admission on the ICU and a temperature of >35.5°C until extubation.
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72 hours
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Workload
Time Frame: 72 hours
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The number of alarms and required interactions between the ventilator and the user during mechanical ventilation on the ICU.
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72 hours
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Usability
Time Frame: Up to 1 day after extubation
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A survey with acceptance score (1-10) completed by the care provider at the bedside who treated the patient for the weaning
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Up to 1 day after extubation
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Patient agitation
Time Frame: Up to 72 hours of mechanical ventilation time
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The number of agitated moments of the patient recognized by the ICU care provider at the bedside.
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Up to 72 hours of mechanical ventilation time
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Administration of sedatives and analgesics
Time Frame: Up to 72 hours of mechanical ventilation time
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The number and dosages of administrations of NSAIDs, opiates, benzodiazepines, clonidine, propofol or haloperidol during mechanical ventilation.
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Up to 72 hours of mechanical ventilation time
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The Richmond Agitation-Sedation Scale (RASS)
Time Frame: Up to 72 hours of mechanical ventilation time
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The RASS for every hour during mechanical ventilation.
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Up to 72 hours of mechanical ventilation time
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Postoperative atelectasis
Time Frame: Up to 48 hours after extubation
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The number of a patients with an atelectasis on the first thoracic x-ray or the thoracic x-ray the following day after surgery.
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Up to 48 hours after extubation
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CO2 levels for postoperative pulmonary shunting
Time Frame: Up to 72 hours of mechanical ventilation time
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The EtCO2/pCO2 ratio during mechanical ventilation.
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Up to 72 hours of mechanical ventilation time
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O2 levels for postoperative pulmonary shunting
Time Frame: Up to 72 hours of mechanical ventilation time
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The pO2/FiO2 ratio during mechanical ventilation.
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Up to 72 hours of mechanical ventilation time
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Reliability of non-invasive oxygen saturation measurement
Time Frame: 72 hours
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The time of mechanical ventilation on the ICU without non-invasive measurement of the oxygen saturation.
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72 hours
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Ashley De Bie Dekker, Msc, Catharina Ziekenhuis Eindhoven
Publications and helpful links
General Publications
- Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014 May;40(5):752-3. doi: 10.1007/s00134-014-3234-7. Epub 2014 Feb 28. No abstract available.
- Lellouche F, Bouchard PA, Simard S, L'Her E, Wysocki M. Evaluation of fully automated ventilation: a randomized controlled study in post-cardiac surgery patients. Intensive Care Med. 2013 Mar;39(3):463-71. doi: 10.1007/s00134-012-2799-2. Epub 2013 Jan 22.
- De Bie AJR, Neto AS, van Meenen DM, Bouwman AR, Roos AN, Lameijer JR, Korsten EHM, Schultz MJ, Bindels AJGH. Fully automated postoperative ventilation in cardiac surgery patients: a randomised clinical trial. Br J Anaesth. 2020 Nov;125(5):739-749. doi: 10.1016/j.bja.2020.06.037. Epub 2020 Jul 30.
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 (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- NL58975.100.16
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Study Data/Documents
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Study Protocol
Information identifier: Study Intensive CareInformation comments: Contact can be made to request the study protocol (Dutch)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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