- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03245684
Assisted or Controlled Ventilation in Ards (Ascovent) (ASCOVENT)
Assessment of the Inflammatory Response Associated With the Increase of Transpulmonary Pressure in Ipoxiemic Patients During Assisted Mechanical Ventilation
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
All patients will be treated according to the sedation protocols and standards of care. Sedation will be guaranteed by continuous infusion of Propofol 2-4 ml / Kg / h, Remifentanil 0.05-0.1 mcg / Kg / min to obtain a RASS scale level of -5 of the RASS. Mio-resolution eventually obtained by a loading dose of 15 mg e.v. followed by a continuous infusion of 37.5 mg / h of besylated Cisatracury, will be reserved for patients with P/F <150.
During a 48 hrs pre-randomization period, control mechanical ventilation will be set with a Tidal Volume (VT) of 6 ml / kg (for ideal weight) and a Pplat limited to 30 cm H2O; inspiratory flow 50-70 l / min with end-of-breath pause of 0.2-0.5 sec, ratio I: E from 1: 1 to 1: 3, respiratory frequency of 20-35 steps to maintain 7.3 <pH <7.5. If the pH is <7.30 the respiratory frequency will increase up to 35 / min; If the pH is> 7.5, the respiratory rate will be progressively reduced to the target pH range. FiO2 and The PEEP will be set according to the ARDSnet table (33)
After 48 hours, the patient will be randomized through one of the following two groups:
Control Mechanical ventilation (CMV): patient's spontaneous activity will be shut done by sedation and/or respiratory muscles paralysis. Volume (during volume control) or pressure (during pressure control), PEEP, FiO2 and respiratory rate will be regulated according the ARDSnet protocol (33).
Pressure Support Ventilation (PSV): patient's spontaneous activity will maintained and sedation will be maintained at a level of Richmond Assessment Sedation Scale (RASS) between -2 and -3. The level of pressure support (including PEEP) will be limited to ≤ 30 cmH2O; the pressure support level will ensure a tidal volume of 6 ml / Kg ideal body weight. PEEP, FiO2 and respiratory rate will be regulated according the ARDSnet protocol (33)
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Patients > 18 years of age who:
- Are intubated less than 24 hours since meeting the Berlin definition criteria for ARDS.
- Have a commitment to full support;
- Have no exclusion criteria
Exclusion Criteria:
- Intubation and mechanical ventilation (any form) for > 24 hours;
- Acute brain injury with Glasgow coma scale (GCS) <7;
- Body mass index > 40;
- Age < 18 years;
- Neuromuscular disease that impairs ability to ventilate without assistance;
- Severe chronic respiratory disease;
- Burns > 40% total body surface area;
- Malignancy or other irreversible disease or condition for which 6-month mortality is estimated to be greater than 50%;
- Allogeneic bone marrow transplant within the last 5 years;
- Chronic respiratory condition making patient respirator dependent;
- Patient, surrogate, or physician not committed to full support;
- Acute myocardial infarction or acute coronary syndrome within 30 days;
- Moribund patient: not expected to survive 24 hours;
- No consent/inability to obtain consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Pressure Support Ventilation
after 48h of controlled ventilation the patient randomised in this arm will desedated and switched on Pressure Support Ventilation (PSV): patient's spontaneous activity will maintained and sedation will be maintained at a level of Richmond Assessment Sedation Scale (RASS) between -2 and -3. The level of pressure support (including PEEP) will be limited to ≤ 30 cmH2O; the pressure support level will ensure a tidal volume of 6 ml / Kg ideal body weight. PEEP, FiO2 and respiratory rate will be regulated according the ARDSnet protocol. assessment of inflammatory response during PSV |
assessment cytokines level in BAL and plasma
|
ACTIVE_COMPARATOR: Controlled Mechanical Ventilation
patient's spontaneous activity will be shut done by sedation and/or respiratory muscles paralysis.
Volume (during volume control) or pressure (during pressure control), PEEP, FiO2 and respiratory rate will be regulated according the ARDSnet protocol
|
assessment cytokines level in BAL and plasma
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pulmonary concentration of inflammation mediators (broncho-alveolar lavage: BAL)
Time Frame: 96 hours
|
Dosage of inflammatory mediators (tumor necrosis factor-α soluble receptors, interleukin-6, interleukin-8 and interleukin-1β and interleukin-1 receptor antagonist)
|
96 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Systemic concentration of inflammation mediators (plasma)
Time Frame: 96 hours
|
The concentrations of the same mediators (tumor necrosis factor-α soluble receptors, interleukin-6, interleukin-8 and interleukin-1β and interleukin-1 receptor antagonist) in a sample of 10 ml of blood taken from a central venous line will be analyzed
|
96 hours
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of ventilator-free days (VFDs) during the 28 days immediately after randomization
Time Frame: 28 days
|
28 days
|
|
Relationship between cytokine concentration and trans-pulmonary pressure
Time Frame: 96 hours
|
End-expiratory and end-inspiratory occlusions will be performed.
End-inspiratory Plateau Pressure.
Pplat of the respiratory system (Pplatrs) will be the value of PAW after an end-inspiratory occlusion.
End-inspiratory chest wall plateau pressure (PplatCW) will be measured as the variation in PES between end-expiratory and end-inspiratory occlusions; end-inspiratory plateau pressure of the lung (Pplatl) were estimated as Pplatrs - PplatCW
|
96 hours
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- ASCOVENT
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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.
Clinical Trials on Inflammatory Response
-
Virginia Polytechnic Institute and State UniversityRecruitingInflammatory ResponseUnited States
-
Utah State UniversityGreenAcres FoundationRecruitingInflammatory ResponseUnited States
-
Assiut UniversityCompleted
-
Norma Osama Abdalla ZayedAbdelhamid, Bassant Mohamed, M.D.CompletedInflammatory ResponseEgypt
-
University of ViennaRecruiting
-
University of Southern CaliforniaNot yet recruiting
-
Utah State UniversityDuke University; United States Department of Agriculture (USDA)Recruiting
-
Galvani BioelectronicsNAMSACompleted
-
NYU Langone HealthTerminatedInflammatory ResponseUnited States
Clinical Trials on assessment of inflammatory response during PSV
-
Children's Hospital of PhiladelphiaNational Heart, Lung, and Blood Institute (NHLBI)Completed
-
University of MalagaUniversity of ChileCompletedHealthy Participants
-
IRCCS Azienda Ospedaliero-Universitaria di BolognaUnknownBowel Endometriosis | Endometriosis, RectumItaly
-
Centre Hospitalier Universitaire de BesanconNot yet recruitingPerineal Tear | Perineum; Rupture | Perineum; Tear
-
Medical University of GrazEuropean Respiratory SocietyRecruitingPulmonary Circulation DiseasesUnited States, Italy, United Kingdom, Austria, Australia, Belgium, Brazil, Denmark, France, Germany, Netherlands, Poland, Spain, Switzerland
-
Direction Centrale du Service de Santé des ArméesActive, not recruitingCovid19 | Burnout, Professional | SARS-CoV Infection | Burnout, CaregiverFrance
-
Direction Centrale du Service de Santé des ArméesInstitut de Recherche Biomedicale des ArmeesCompleted
-
Aretaieion University HospitalRecruitingStress | Anesthesia | Music | Auditory PerceptionGreece
-
Medical University of SilesiaUnknownObesity | Predictive Value of Tests | Intubation, IntratrachealPoland
-
University Hospital Inselspital, BerneCompleted