- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03803358
NIV-Training in Hypercapnic COPD Patients
The Effects of Non-invasive Ventilation During Cycle Exercise Within a 3-week Pulmonary Rehabilitation Program in COPD Patients With Chronic Hypercapnic Respiratory Failure - a Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Scientific Background/ Rationale:
Quality of life and exercise tolerance are commonly reduced in people with chronic obstructive pulmonary disease (COPD), especially in people with chronic hypercapnic respiratory failure (CHRF). Endurance exercise training as part of a pulmonary rehabilitation (PR) programme is an important treatment for people with COPD and has been shown to improve quality of life, exercise tolerance and physical activity. However, individuals with CHRF may have difficulties performing endurance exercise at an adequate training intensity to achieve the desired physiological changes.
Non-invasive ventilation (NIV) is a method of providing breathing support using a ventilator and is usually delivered via a full face mask. A recent study showed that during a single exercise session in people with CHRF, NIV dramatically improves exercise tolerance and reduces breathlessness. Consequently, NIV used over a complete exercise training program may allow people with COPD and CHRF to exercise at a higher intensity to achieve greater improvement in exercise tolerance, quality of life and physical activity. So far this has only been tested in a small number of studies with small numbers of participants, and none with CHRF. It is currently not known from literature whether the demonstrated benefits of NIV during exercise training are clinically worthwhile or cost-effective.
Aims The aim of the study is to investigate the additional effects of the use of NIV during exercise within a 3-week PR program on exercise capacity in COPD patients with chronic hypercapnic respiratory failure.
Hypothesis It is assumed that a 3-week exercise training program with additional NIV, using titrated pressures, reduces the work of breathing. With this, it is theorized, COPD patients with CHRF are able to train for a longer duration and/ or with higher training intensities over the course of the training program and may achieve better PR outcomes.
Primary Hypothesis:
H.0: COPD-Patients with CHRF have the same increase in exercise capacity (endurance cycle time) when training with additional NIV as without NIV, during a 3-week PR program.
H.1: COPD-Patients with CHRF have a superior increase in exercise capacity (endurance cycle time) when training with additional NIV as without NIV, during a 3-week PR program.
Main Objective To determine if NIV during exercise is a useful tool for increasing exercise tolerance in hypercapnic patients, exercise tolerance (cycle endurance time) will be measured without NIV at PR admission/ discharge
Materials and Method A total of 26 COPD patient (age: 40-80 years) in GOLD Stages IV diagnosed with CHRF, already treated with nocturnal NIV and referred for a comprehensive PR program will be recruited and randomized into two groups: 1) exercise with NIV during exercise (nocturnal NIV will continue) and 2) control group - exercise without NIV during exercise (nocturnal NIV will continue).
Initially, patients will perform a maximum cardiopulmonary test to determine the Peak Work Rate (WRpeak). On a separate day, patients will perform a cycle endurance test (CET) at 75%WRpeak without NIV using oxygen as prescribed, if needed. TcPCO2, heart rate and SpO2 via SenTec will be measured continuously during CET. In addition to the continuously recorded data, dyspnoea/ respiratory effort/ leg-fatigue (10-point Borg scale), capillary blood gases and the arterial blood pressure will be taken at the beginning/ end/ recovery/ isotime of the CET.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Bayern
-
Schönau Am Königssee, Bayern, Germany, 83471
- Schoen Klinik Berchtesgadener Land
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Diagnosis of very severe COPD Gold Stage IV
- Age: 40-80 years
- PaCO2 >50mmHg (at rest, during sleep or exercise)
- Implemented nocturnal non-invasive ventilation therapy
Exclusion Criteria:
- Concomitant cardiovascular, orthopaedic or neurological conditions that are likely to be the primary impairment to exercise performance
- Other significant pulmonary disease which could affect exercise or NIV (e.g. asthma)
- BMI > 35 kg/m2
- Inability to give informed consent
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 |
---|---|
Experimental: cycle exercise with additional NIV
In the intervention group (exercise training with non-invasive ventilation) exercise NIV pressures will be optimally adjusted to each individual patient to decrease TcPCO2 values.
An IPAP of at least 15 cmH20 will be used to provide sufficient pressure to relief patients breathing muscles.
Nocturnal NIV will be continued.
|
In the intervention group (exercise training with non-invasive ventilation) exercise NIV pressures will be optimally adjusted to each individual patient to decrease TcPCO2 values.
An IPAP of at least 15 cmH20 will be used to provide sufficient pressure to relief patients breathing muscles.
Nocturnal NIV will be continued.
|
Active Comparator: cycle exercise without NIV
In the control Group (standard exercise training without NIV ), patients will be execute cycle exercise without additional NIV (usual care).
Nocturnal NIV will be continued.
|
In the control Group (standard exercise training without NIV ), patients will be execute cycle exercise without additional NIV (usual care).
Nocturnal NIV will be continued.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Exercise tolerance
Time Frame: Day 1 and Day 21
|
Change in cycle endurance time without NIV within PR
|
Day 1 and Day 21
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Partial pressure of transcutaneous carbon dioxide
Time Frame: Day 1 and Day 21
|
Change in partial pressure of carbon dioxide levels during CET, recorded via SenTec (Switzerland, Therwill)
|
Day 1 and Day 21
|
Oxygen saturation
Time Frame: Day 1 and Day 21
|
Change in Oxygen Saturation during CET, recorded via SenTec (Switzerland, Therwill)
|
Day 1 and Day 21
|
Heart rate
Time Frame: Day 1 and Day 21
|
Change in Heart Rate during CET, recorded via SenTec (Switzerland, Therwill)
|
Day 1 and Day 21
|
Partial pressure of carbon dioxide
Time Frame: Day 1 and Day 21
|
Change in partial pressure of carbon dioxide pre/ post CET, recovery, isotime, recorded via capillary taken blood gases
|
Day 1 and Day 21
|
Partial pressure of oxygen
Time Frame: Day 1 and Day 21
|
Change in partial pressure of oxygen pre/ post CET, recovery, isotime, recorded via capillary taken blood gases
|
Day 1 and Day 21
|
Arterial blood pressure
Time Frame: Day 1 and Day 21
|
Change in arterial blood pressure pre/ post CET, recovery, isotime
|
Day 1 and Day 21
|
Patients perception - Dyspnoe
Time Frame: Day 1 and Day 21
|
Change in perceived dyspnoea /respiratory effort pre/ post CET, recovery, isotime recorded via Borg Scale
|
Day 1 and Day 21
|
Patients perception - leg fatigue
Time Frame: Day 1 and Day 21
|
Change in perceived leg fatigue pre/ post CET, recovery, isotime recorded via Borg Scale
|
Day 1 and Day 21
|
Patients Quality of life - Chronic Respiratory Questionnaire
Time Frame: Day 1 and Day 21
|
Change in Chronic Respiratory Questionnaire
|
Day 1 and Day 21
|
Patients Quality of life - Severe Respiratory Insufficiency Questionnaire
Time Frame: Day 1 and Day 21
|
Change in Severe Respiratory Insufficiency Questionnaire
|
Day 1 and Day 21
|
Anxiety and Depression
Time Frame: Day 1 and Day 21
|
Change in Hospital Anxiety and Depression Scale
|
Day 1 and Day 21
|
Maximal voluntary muscle contraction
Time Frame: Day 1 and Day 21
|
Change in muscle contraction force (m.
rectus femoris) recorded via MicroFet
|
Day 1 and Day 21
|
Patients perception to physical Training with additional NIV
Time Frame: Day 1 and Day 21
|
Patients in the Intervention Group will be interviewed how they perceived the Treatment, via a questionnaire with open- and closed ended questions
|
Day 1 and Day 21
|
Collaborators and Investigators
Investigators
- Principal Investigator: Klaus Kenn, Prof. Dr., Philipps University of Marburg, Department of pulmonary rehabilitation
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- NIV-Training
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 COPD
-
University Medical Center GroningenCompleted
-
Istituto Nazionale di Ricovero e Cura per AnzianiRecruiting
-
Bio-Sensing Solutions S.L. (DyCare)Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau; Centre...Not yet recruiting
-
Sir Run Run Shaw HospitalRecruiting
-
University Hospital, BrestRecruiting
-
The First Affiliated Hospital of Guangzhou Medical...Recruiting
-
Association des Réseaux BronchioliteLaboratoire Système et Matériaux pour la Mécatronique (SYMME)Recruiting
-
Baylor Research InstituteNot yet recruiting
-
Polytechnic Institute of PortoNippon Gases PortugalRecruiting
Clinical Trials on exercise training with non-invasive ventilation
-
University Hospital, GrenobleTerminatedRespiratory Acidosis in ICU PatientsFrance
-
ADIR AssociationCompletedChronic Obstructive Pulmonary Disease | Non Invasive Ventilation | Exercise, AerobicFrance
-
Spaulding Rehabilitation HospitalCompletedSpinal Cord InjuryUnited States
-
University of Lausanne HospitalsCompletedHealthy Volunteer | Non-invasive Ventilation | High-frequency VentilationSwitzerland
-
Instituto Dante Pazzanese de CardiologiaCompletedHeart Failure | Acute Heart Failure
-
Guy's and St Thomas' NHS Foundation TrustCompletedMotor Neurone Disease | Hypoxemia and/or HypercapniaUnited Kingdom
-
Centre Chirurgical Marie LannelongueCentre Hospitalier René Dubos; University Hospital, Bordeaux; University Hospital... and other collaboratorsCompletedRespiratory InsufficiencyFrance
-
University Hospital, AngersRecruitingAcute Respiratory FailureFrance
-
The University of Texas Health Science Center,...TerminatedChronic Respiratory FailureUnited States
-
Fondazione Don Carlo Gnocchi OnlusFondazione Salvatore MaugeriCompleted