- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04362787
High Pressure Non Invasive Ventilation in Hypercapnic Respiratory Failure
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Noninvasive ventilation (NIV): refers to the administration of ventilatory support without using an invasive artificial airway (endotracheal tube or tracheostomy tube). NPPV is well established in the management of acute on chronic hypercapnic respiratory failure secondary to acute exacerbation of COPD (AECOPD), obesity hypoventilation syndrome, and restrictive thoracic disorders.
During the past years NIV was applied by using low pressure inspiratory positive airway pressure (IPAP), which means titrating inspiratory pressure starting at 10 cmH2O and increasing pressure gradually according to patient tolerance maximum up to 20 cm H2O.
There is still about 15% failure rate while using conventional low pressure NIV, this failure rate may be attributed to the following:
- Still in a number of patients with conventional low pressure NIV, PaCO2, and pH worsen with subsequent deterioration and need for invasive ventilation.
- Despite lowering PaCO2 value with conventional NIV ventilation but it is not normalized so with minimal derangement in clinical condition of the patient it worsens again.
- Also abnormally high level PaCO2 may have a negative impact on vital organs.
- Low pressure may be associated with patient intolerance , and discontinuation of NIV.
Recently high pressure NIV used aiming to improve outcome of NIV. High pressure NIV is a pressure limited ventilation, stating IPAP pressure at 20 cmH2O and gradually increasing pressure up to 30 cmH2O according to patient tolerance. High pressure NIV is expected to improve alveolar ventilation, decreasing dead space ventilation, and work of breathing, so it can improve the outcome result .
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Maha Ei Abdelhafeez, Master
- Phone Number: 01065854758 010911477791
- Email: mahaeissa2018@gmail.com
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
All patients admitted in Assiut University Hospital and Assiut Police Hospital with acute hypercapnic respiratory failure due to COPD and Obesity hypoventilation syndrome (OHS) indicated for conventional NIV.
Patients who failed on low pressure NIV will be shifted to high pressure NIV with any of these conditions:
- PH <7.30 or less than admission level.
- RR > 35b/m or more than admission level.
- SpO2 < 88%.
Exclusion criteria: (4)
- Age <18 years.
- Excessive amount of respiratory secretions or weak cough.
- Upper airway obstruction.
- Recent oral, facial or cranial trauma or surgery.
- Sever abdominal distension.
- Active upper gastrointestinal bleeding.
- Cardiac or respiratory arrest.
- PH<7.25.
- Arterial oxygen tension /fraction of inspired oxygen (PaO2 / FiO2) <150mmHg.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
High pressure _ low pressure non-invasive ventilation
In the high-pressure NIV,52 patients will undergo pressure-limited NPPV at a higher IPAP level. IPAP is initially set at 20 cmH2O and continuously adjusted by increments and decrements of 1-2 cmH2O (up to 30 cmH2O), according to patients' tolerance, to obtain a tidal volume (VT) of 15 mL/kg of IBW. 2- EPAP for patients with COPD will be started at EPAP 5 and will be increased till 7 and for the patients with hypoventilation syndrome will be increased up to EPAP 8. 3-Respiratory rate 10-12 b/min. |
Usage of High pressure non invasive ventilation in acute hypercapnic respiratory failure
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
High pressure non invasive ventilation in acute hypercapnic respiratory failure
Time Frame: Patients will assessed after 2 hours from increasing pressure
|
To study the efficacy of safety of high pressure NIV in acute hypercapnic respiratory failure due to COPD and obesity hypoventilation syndrome who refractory to low pressure NIV.
|
Patients will assessed after 2 hours from increasing pressure
|
High pressure non invasive ventilation in acute hypercapnic respiratory failure
Time Frame: Patients will assessed after 2 hours from increasing pressure
|
Effect of high pressure NIV on length of hospital stay , need for invasive mechanical ventilation, mortality.
|
Patients will assessed after 2 hours from increasing pressure
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Khaled Hu Ahmed, Professor of chest diseases Faculty of medicine Assiut university
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
- High pressure
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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