- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04241861
High-flow Nasal Cannula vs. Helmet PSV vs. Helmet CPAP During Respiratory Failure (HIGHFLOWHELMET)
Physiological Comparison of High-flow Nasal Cannula, Helmet Pressure Support Ventilation and Continuous Positive Airway Pressure During Acute Hypoxemic Respiratory Failure: a Randomized Cross-over Study
Study Overview
Status
Conditions
Detailed Description
Setting: 21-bed general ICU, emergency room of the Emergency department (ED), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy..
Patients: adult hypoxemic non-hypercapnic patients admitted to the emergency department or the ICU with de novo acute respiratory failure will be assessed for the enrolment.
Each eligible patient, in the absence of exclusion criteria, will receive 15 minutes of heated and humidified 60% oxygen at a rate of 50 l/min via a non-rebreathing face mask. An ABG will be then collected and PaO2/FiO2 ratio computed: given the high flows used, actual FiO2 will be approximated to the set one.
Nonhypercapnic patients with a PaO2/FiO2≤200 mmHg will be enrolled. In the absence of exclusion criteria and if all other inclusion in criteria are met, patients showing PaO2/FiO2≤300 and >200 mmHg will be treated according to the clinical practice eventually reassessed for the presence of oxygenation criterion subsequently.
Enrolled patients will receive all the interventions (helmet CPAP, PSV and high-flow nasal cannula) in a randomized, cross-over fashion, for 40 minutes each.
At the end of the study, the patient will receive the treatment that will be shown as more appropriate for the patient, according to the attending physician, who will be informed about the results of the study on the individual patient.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Rome, Italy
- Fondazione Policlinico Universitaro A. Gemelli IRCCS
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Patients: adult hypoxemic non-hypercapnic patients admitted to the emergency department or the ICU with de novo acute respiratory failure will be assessed for the enrolment.
Patients will be considered eligible whether all the following inclusion criteria are met:
- Respiratory rate>25 bpm.
- PaO2/FiO2 ≤200 in the supine position, measured after 15 minutes of high flow treatment with face mask (60 l/min, temperature of the humidification chamber set at 37°C, FiO2 set to achieve a SpO2 >92% and <98%). Given the use of the high flows, nominal FiO2 will be considered a reliable estimate of the actual one.
- PaCO2 <45mmHg
- Absence of history of chronic respiratory failure or moderate to severe cardiac insufficiency.
- Written informed consent
Exclusion Criteria:
- Exacerbation of asthma or chronic obstructive pulmonary disease;
- Cardiogenic pulmonary oedema;
- Haemodynamic instability (Systolic blood pressure <90 mmHg or mean arterial pressure <65 mmHg) and/or lactic acidosis (lactate >5 mmol/L) and/or clinically diagnosed Shock
- Metabolic Acidosis (pH <7.30 with normal- or hypo-carbia);
- Glasgow coma scale <13;
- Recent head surgery or anatomy that prevent the application of helmet or nasal cannula to patient's face.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: CROSSOVER
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: High-flow oxygen therapy
Nasal high flow oxygen therapy will be delivered with the Optiflow system.
Initial set flow will be ≥ 50 /min and flows will be decreased in case of intolerance and/or according to patients' requirements: flows≥30 L/min will be mandatory in all enrolled patients.
Humidification chamber (MR860, Fisher and Paykel healthcare, New Zealand) will be set at 37 °C or 34 °C according to patient's comfort33.
FiO2 will be titrated to obtain an SpO2≥92% and ≤98%.
|
Noninvasive respiratory support respiratory support
|
EXPERIMENTAL: Helmet PSV
Dedicated helmets for noninvasive ventilation will be used and size will be chosen according to neck circumference or according to manufacturer recommendations. Each patient will be connected to a compressed-gas based ventilator through a bitube circuit with no humidification. The ventilator will be set in PSV, with the following suggested settings 34-38:
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Noninvasive respiratory support respiratory support
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EXPERIMENTAL: Helmet CPAP
Dedicated helmets for noninvasive ventilation will be uses and size will be chosen according to neck circumference or according to manufacturer recommendations. Treatment will be delivered through a high-flow generator. The following settings will be applied:
|
Noninvasive respiratory support respiratory support
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Inspiratory effort
Time Frame: 40 minutes
|
The negative deflection in esophageal pressure during inspiration
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40 minutes
|
Tidal volume
Time Frame: 40 minutes
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The tidal change in lung impedance, assessed by electrical impedance tomography
|
40 minutes
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Oxygenation
Time Frame: 40 minutes
|
Ratio of PaO2 to FiO2
|
40 minutes
|
Tidal volume distribution
Time Frame: 40 minutes
|
Distribution of tidal volume within the lung regions, assessed by electrical impedance tomography
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40 minutes
|
Carbon dioxide
Time Frame: 40 minutes
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Blood carbon dioxide, measured with the arterial blood gas analysis
|
40 minutes
|
Respiratory rate
Time Frame: 40 minutes
|
Respiratory rate/minute, assessed with the esophageal pressure
|
40 minutes
|
Dyspnea
Time Frame: 40 minutes
|
Dyspnea assessed with the visual analog scale, 0-10 scale where the highest value corresponds to the highest degree of dyspnea
|
40 minutes
|
Comfort
Time Frame: 40 minutes
|
Comfort assessed with the visual analog scale, 0-10 scale where the highest value corresponds to the highest degree of discomfort
|
40 minutes
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Global impedance-derived End-expiratory lung volume
Time Frame: 40 minutes
|
End-expiratory lung volume, measured with electrical impedance tomography
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40 minutes
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Regional impedance-derived End-expiratory lung volume
Time Frame: 40 minutes
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End-expiratory lung impedance in the four regions of the lungs (ventral, mid-ventral, mid-dorsal, dorsal), measured with electrical impedance tomography
|
40 minutes
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Dynamic transpulmonary driving pressure
Time Frame: 40 minutes
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The tidal change in transpulmonary pressure
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40 minutes
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Global impedance-derived lung dynamic strain
Time Frame: 40 minutes
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Change in impedance due to tidal volume / end expiratory lung impedance, both measured with electrical impedance tomography
|
40 minutes
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Regional impedance-derived lung dynamic strain
Time Frame: 40 minutes
|
Change in impedance due to tidal volume / end expiratory lung impedance in the four regions of the lungs (ventral, mid-ventral, mid-dorsal, dorsal), measured with electrical impedance tomography
|
40 minutes
|
Respiratory system dynamic compliance
Time Frame: 40 minutes
|
Ratio of the tidal change in lung impedance to dynamic transpulmonary driving pressure
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40 minutes
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Pendelluft
Time Frame: 40 minutes
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Occurrence of intra-tidal shift of gas within different lung regions at beginning of inspiration
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40 minutes
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Work of breathing
Time Frame: 40 minutes
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Esophageal pressure simplified pressure time product per minute
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40 minutes
|
Collaborators and Investigators
Investigators
- Principal Investigator: Massimo Antonelli, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Principal Investigator: Domenico L Grieco, MD, Fondazione Policlinico Universitario A. Gemelli, IRCCS
Publications and helpful links
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2693
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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