- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03356496
Preoperative Self-managed Respiratory Therapy for Reduction of Postoperative Pulmonary Complications (PRESMART)
August 25, 2022 updated by: Hari Paudel, Medical College of Wisconsin
Preoperative Self-managed Respiratory Therapy for Reduction of Postoperative Pulmonary Complications After Non-cardiothoracic Surgery
Postoperative pulmonary complications (PPCs) are a source of much morbidity and mortality.
Rates of PPCs exceed 30% in patients with multiple risk factors.
Several studies have demonstrated reduced PPCs in patients who underwent preoperative inspiratory muscle training.
These studies largely focused on cardiothoracic surgery and required the use of respiratory therapists.
The investigators hypothesize that preoperative, self-administered respiratory therapy would reduce PPCs in patients with risk factors for PPCs undergoing any non-cardiothoracic surgery.
This study is a randomized, controlled trial comparing preoperative use of an incentive spirometry device with usual care in patients undergoing non-emergent, non-cardiothoracic surgical procedures under general anesthesia.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Detailed Description
Postoperative pulmonary complications account for >50% of all adverse postoperative events and are more costly and carry greater comorbidity than cardiac complications.
Much research has been performed to identify potential risk reduction strategies for PPCs.
Until recently all of these focused on intraoperative and postoperative interventions, including lung-protective mechanical ventilation, lung expansion techniques, and use of regional anesthesia and analgesia.
In the last few years several studies have investigated the potential role of preoperative interventions to improve respiratory status.
These studies have demonstrated benefit from preoperative inspiratory muscle training (IMT).
A recent systematic review found that any preoperative intervention, such as education, IMT, exercise training or relaxation reduced PPC rates.
However, these studies have focused on cardiothoracic and abdominal surgery, and almost all have utilized respiratory therapist-directed interventions.
Likely due to the additional costs and difficulty of arranging respiratory therapy on an outpatient basis, this promising new risk mitigation strategy has yet to be adopted on a large scale.
Incentive spirometry devices offer a potentially easier and less costly preoperative respiratory intervention.
Incentive spirometers are a drug-free, easy to use, hand-held device that promotes deep breathing and respiratory muscle strength by providing visual feedback during sustained inhalation.
It opens weak or collapsed airways to mobilize and assist mucociliary clearance to the upper airways where it can be coughed out.
This study evaluates the hypothesis that providing preoperative, patient self-directed respiratory therapy with use of an incentive spirometry device will reduce the incidence of PPCs in patients with increased pulmonary risk undergoing any major, non-cardiothoracic surgery with general anesthesia.
Study Type
Interventional
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Wisconsin
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Milwaukee, Wisconsin, United States, 53226
- Froedtert Hospital
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Intermediate or high risk for postoperative pulmonary complications as defined by ARISCAT score >25
- Undergoing non-cardiothoracic surgery scheduled at least 7 days in the future
- Planned general anesthesia (alone or in combination with regional or neuraxial anesthesia)
- Personal internet access
Exclusion Criteria:
- Active bronchospasm during preoperative clinic visit
- History of pneumothorax
- History of tracheal stoma or ventilator dependency
- Pregnancy
- Chronic oxygen requirement
- Deficient motor and/or visual function that will prohibit utilization of the device or instructional video and handout
- Lack of English language proficiency
- Inability to consent
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Intervention
Patient provided with instructions and video for the use of an incentive spirometry device.
Patient instructed to use incentive spirometry device as frequently as every hour while awake but at least 4 times daily for at least 10 breathing cycles for 1-3 weeks before surgery.
Patient instructed to record usage and any physical complaints in a diary.
|
Incentive spirometry device provides improved lung expansion and respiratory muscle strength
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NO_INTERVENTION: Control
Patient receives only usual care as provided by perioperative healthcare providers.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Postoperative pulmonary complications
Time Frame: Up to 30 days after surgery
|
Composite of hypoxemia (pulse oximetry <88% with provision of oxygen therapy beyond 24 hours after surgery); bronchospasm (new wheezing or bronchospasm with provision of bronchodilator therapy); hypercarbia (serum bicarbonate or arterial or end-tidal carbon dioxide level above reference range treated with provision of mechanical ventilation); atelectasis (radiographic evidence of atelectasis plus respiratory symptoms or abnormal lung exam findings); respiratory infection (patient received antibiotics for suspected respiratory infection and had at least 1 of following: new or changed sputum, new or changed lung opacities on chest radiograph, fever, or leukocyte count >12,000/microliter); pleural effusion (radiographic evidence of pleural effusion and performance of thoracentesis); pneumothorax (radiographic evidence of pneumothorax); and ventilatory failure (replacement of endotracheal tube or mechanical ventilation for >48 hours postoperatively)
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Up to 30 days after surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mortality
Time Frame: Up to 30 days after surgery
|
Patient death from any cause
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Up to 30 days after surgery
|
Length-of-stay
Time Frame: Up to 30 days after surgery
|
Number of days of hospitalization after index surgery
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Up to 30 days after surgery
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Readmission
Time Frame: Up to 30 days after surgery
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Incidence of rehospitalization after index surgery
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Up to 30 days after surgery
|
Unanticipated hospital admissions
Time Frame: Up to 30 days after surgery
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Incidence of inpatient admission after index surgery that was planned as outpatient
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Up to 30 days after surgery
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Unanticipated hospital observation
Time Frame: Up to 30 days after surgery
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Incidence of admission for observation for recovery after index surgery planned as outpatient
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Up to 30 days after surgery
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Unanticipated intensive care unit utilization
Time Frame: Up to 30 days after surgery
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Incidence of intensive care admission after index surgery not planned for intensive care unit admission
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Up to 30 days after surgery
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, Sabate S, Mazo V, Briones Z, Sanchis J; ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010 Dec;113(6):1338-50. doi: 10.1097/ALN.0b013e3181fc6e0a.
- Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015 Oct 5;2015(10):CD010356. doi: 10.1002/14651858.CD010356.pub2.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ACTUAL)
January 22, 2020
Primary Completion (ACTUAL)
May 27, 2021
Study Completion (ACTUAL)
May 27, 2021
Study Registration Dates
First Submitted
November 9, 2017
First Submitted That Met QC Criteria
November 28, 2017
First Posted (ACTUAL)
November 29, 2017
Study Record Updates
Last Update Posted (ACTUAL)
August 29, 2022
Last Update Submitted That Met QC Criteria
August 25, 2022
Last Verified
August 1, 2022
More Information
Terms related to this study
Other Study ID Numbers
- PRO00030057
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
product manufactured in and exported from the U.S.
Yes
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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