- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03411928
Endotracheal Dilator to Improve Oxygenation (EDITION2)
Modified Endotracheal Balloon Dilator to Improve Oxygenation During Airway Procedures in Children With Tracheal Stenosis
Study Overview
Status
Intervention / Treatment
Detailed Description
This study is a prospective, single arm, observational study of patients at Red Cross War Memorial Children's Hospital receiving treatment for laryngotracheal stenosis using a modified tracheal dilatation balloon. The tracheal balloon dilatation procedure is clinically well-established and is standard practice in the study institution. In this study, a modified, improved tracheal balloon will be used to treat patients. Data to be collected during the procedure include measurement of the stenotic segment prior to and after dilatation, using both the modified Myer-Cotton grading system and sizing the stenosis using endotracheal tubes diameter, documenting the site of the stenosis (distance from vocal cords), periprocedural oxygen saturation nadir (using plethysmography) and heart rate. All other procedures will be as per routine care. Each procedure will be monitored by a senior anaesthetist who is not a member of the research team. Their role will be to ensure the safety of the patient.
The tracheal balloon dilatation device consists of a catheter tube which has an inflation port at its proximal end and a balloon at its distal end. The balloon is provided in a narrow, folded condition to allow entering and traversing the stenotic portion of the airway. As with all tracheal dilatation balloons, when inflated with an inflator equipped with a pressure manometer, the device generates an outward radial force to dilate the stenotic portion of the airway. The balloon differs from previous devices used for dilatation of tracheal stenosis in that it is modified to have a large central channel when inflated, which allows gas flow through the balloon.
All materials in the device are medical grade and sourced from specialist medical suppliers. The balloons specifically have undergone biocompatibility testing according to ISO 10993-1 (Biological testing of medical devices) and passed all tests. Safety of the devices has been rigorously demonstrated through in vitro bench testing, and balloons have been shown to survive a minimum of 10 inflations to rated burst pressure without bursting. The devices are manufactured by a facility experienced in production of endovascular balloons, in an ISO 14644 Class 7 compliant clean-room in a manufacturing facility that has a certified ISO 13485 quality management system. The balloons are tested as part of an ongoing quality control process, to ensure that tight tolerances are maintained in terms of wall thickness, nominal diameter and rated burst pressure. Furthermore, every tracheal balloon device will have been pressure tested to 16 atm before being used, to ensure that no leaks are present.
The device has been assessed in three previous studies, in manikin, animal and adult human use settings. The studies proved that it is possible to adequately ventilate patients through the modified balloon dilation device. There was no incident of arterial desaturation below 90%. No serious adverse events were recorded.
The study will be conducted over a 12 week period, with an average of 1 patient per week undergoing the procedure at the study site. Recruitment is thus estimated at 12 patients (not procedures).
All research and procedures will take place at Red Cross War Memorial Children's Hospital. Patients will be treated in the operating theatres and will recover in the recovery room, followed by the ENT ward. Patients who have suspected airway narrowing and present to the Department of Otolaryngology will be approached by for potential involvement in the study. The process will be explained obtain written informed consent obtained. The patient will then be treated as per routine care and will be included in the study should inclusion and exclusion criteria be satisfied.
All patients will undergo a thorough routine preoperative assessment. Anaesthesia will be standardized in the absence of specific complication. Routine continuous operative monitoring will be used for all cases, including electrocardiogram, non-invasive automatic blood pressure and pulse oximetry.
A rigid laryngoscope will be inserted into the patient's airway and placed in suspension. The level and severity of the stenosis will be evaluated and the tracheal balloon dilator will be placed at the level of the stenosis under direct vision, using an endoscope. The patient will be kept breathing spontaneously if they do not have a tracheostomy tube. Ventilation will be maintained using a tracheostomy tube, if available.
The balloon will be inflated with water using an inflation device, under direct vision. The pressure in the balloon will be adjusted to 6-8 atmospheres and maintained for at least 1 minute, unless arterial desaturation occurs (SpO2 < 90%) Dilatation will be performed 3 times.
Heart rate and peripheral arterial oxygen saturation will be continuously monitored throughout the procedure. These values will be recorded automatically at one-minute intervals from induction until completion of the dilatation phase, and then at 2.5-minute intervals until recovery from anaesthesia. The stenosis will be graded according to the Myer-Cotton staging system for subglottic stenosis, as well as, the internal diameter of the stenosis being measured (using an endotracheal tube) before and after dilatation.
Adverse events will be recorded in data collection forms. Adverse events will include:
- Arterial desaturation below 90%
- Loss of airway patency
- Inability to ventilate
- Patient coughing or movement
- Haemorrhage
- Inability to pass the bronchoscope
- Balloon failure
- False passage
- Tracheal injury
- Oesophageal injury
- Gastric haemorrhage
- Pneumothorax
- Pneumomediastinum
- Subcutaneous emphysema
- Vocal cord injury
- Mediastinitis
- Chest pain
- Laryngospasm
- Bronchospasm
- Atelectasis
- Pulmonary oedema
- Hypoxia
- Aspiration of water (in case of balloon failure)
Data analysis Data will be collected intraoperatively using a data collection form. This will be transferred to an electronic spreadsheet for analysis. As this is a single-arm study without control devices, no comparative statistics will be calculated. Where appropriate, data will be expressed as mean ± standard deviation.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Jessica McGuire, FCORL
- Phone Number: +27722072991
- Email: jessica.mcguire@uct.ac.za
Study Contact Backup
- Name: Ross Hofmeyr, FCA(SA)
- Phone Number: +27845499259
- Email: ross.hofmeyr@uct.ac.za
Study Locations
-
-
Western Cape
-
Cape Town, Western Cape, South Africa, 7925
- Groote Schuur Hospital
-
Contact:
- Ross Hofmeyr, FCA(SA)
- Phone Number: +27214045003
- Email: ross.hofmeyr@uct.ac.za
-
Sub-Investigator:
- Reuben Smith, MBChB
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Refractory stenosis not amenable to balloon dilatation
- Contraindication to balloon dilatation (long-segment stenosis)
- Patient refusal
Exclusion Criteria:
- Refractory stenosis not amenable to balloon dilatation
- Contraindication to balloon dilatation (long-segment stenosis)
- Patient refusal
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Tracheolator
Tracheal dilatation using the study device as per the protocol.
|
'Tracheolator' non-occlusive tracheal dilation balloon manufactured by Disa Life Sciences, Cape Town, South Africa.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in internal tracheal stenosis diameter
Time Frame: Immediate
|
Post-dilation change from pre-dilatation values, measured using Myer-Cotton grade and millimeter value
|
Immediate
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Peripheral arterial oxygenation
Time Frame: Immediate
|
Oxygen saturation nadir as determined by plethysmography
|
Immediate
|
Change in internal tracheal stenosis diameter
Time Frame: 6 weeks post dilatation
|
Change from pre- and post-dilatation values, measured using Myer-Cotton grade and millimeter value
|
6 weeks post dilatation
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Ross Hofmeyr, FCA(SA), University of Cape Town
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
- UCT_ENT_Anaes_201801
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
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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