- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04640948
High VS Low Flow Nasal O2 for Acute Hypercapnic Respiratory Failure
High Flow Nasal Cannula Therapy for Initial Oxygen Administration in Acute Hypercapnic Respiratory Failure - A Comparison Study of Two Current Standards of Care
Chronic lung conditions such as smoking related lung damage lead to breathing fail. This results in accumulation of gases such as carbon-di-oxide in the body especially during periods of illness known as exacerbation.
Current management of carbon-di-oxide accumulation is administration of oxygen, nebulisers, antibiotics etc and if necessary, provide a tight fitting mask around the face to provide breathing support. If this fails, then a patient is placed on a mechanical ventilator. The tight fitting mask therapy is also called non-invasive ventilation and is used widely but patients acceptability of the therapy is limited.
Providing a high flow of air with some oxygen could potentially provide the same benefit of the non-invasive ventilation and may also be better accepted by patients.
Currently the knowledge and evidence from studies suggest a beneficial role for this high flow therapy but this has not been investigated in well designed studies.
In the proposed study we aim to investigate whether use of the high flow therapy reduces the need for non-invasive ventilation in patients who present with a recent onset accumulation of carbon-di-oxide in their body due to long-term lung disease. If this shows benefit, it will lead to a bigger trial with patient benefiting by reduction in the non-invasive ventilation or indeed a need for an invasive breathing machine.
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Murali Shyamsundar, MD, PhD
- Phone Number: +44 (0)28 9097 6381
- Email: Murali.Shyamsundar@qub.ac.uk
Study Contact Backup
- Name: Asem Alnajada, MSc
- Email: aalnajada01@qub.ac.uk
Study Locations
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-
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Belfast, United Kingdom
- Recruiting
- Royal Victoria Hospital
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Belfast, United Kingdom
- Recruiting
- Mater Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adult patients > 18 years of age
- Acute Hypercapnic respiratory failure with pH < 7.35 and pCO2 > 6 KPa
Exclusion Criteria:
- Age < 18 years
- Pregnant or Breast-Feeding
- Patient cannot read and understand English
- Hypercapnia secondary to a drug toxicity or non-pulmonary aetiology
- Hypercapnia secondary to exacerbation of asthma
- Contraindication to NIV
- Contraindication to HFNC
- Not for escalation to NIV
- pH < 7.15
- GCS 8 or less
- Shock defined as systolic < 90 mmHg or a reduction by 20mmHg from usual systolic BP despite volume resuscitation
- Respiratory or cardio-respiratory arrest
- Any other indication that requires immediate invasive/non-invasive mechanical ventilation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: High flow nasal therapy (HFNT)
Characterized by an elevated arterial CO2 (PaCO2) level of > 6kPa due to ventilatory failure.
The ventilatory failure relates to the imbalance between the respiratory demand and the capacity of the respiratory system to match the demand.
|
Controlled oxygen administration using at least 20 L/min of flow rate and titrated up as tolerated.
Titration of supplemental oxygen to an arterial saturation between 88 - 92%.
Other Names:
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ACTIVE_COMPARATOR: Low flow oxygen (LFO)
Characterized by an elevated arterial CO2 (PaCO2) level of > 6kPa due to ventilatory failure.
The ventilatory failure relates to the imbalance between the respiratory demand and the capacity of the respiratory system to match the demand.
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Controlled oxygen administration using (venturi mask or nasal cannulae) titrated to an arterial saturation between 88 - 92% as the initial oxygen administration method with a flow rate of <20 L/min.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients requiring NIV in each cohort
Time Frame: 6 hours
|
Proportion of patients who require NIV by 6 hours of intervention.
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6 hours
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PaCO2 in Kilopascal
Time Frame: 1 hour, 6 hours and 24 hours.
|
Blood arterial PCO2 level measured at the pre-specified timepoints or at the nearest timepoint.
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1 hour, 6 hours and 24 hours.
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PaO2 in Kilopascal
Time Frame: 1 hour, 6 hours and 24 hours.
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Blood arterial PaO2 level measured at the pre-specified time-points or at the nearest time-point.
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1 hour, 6 hours and 24 hours.
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pH
Time Frame: 1 hour, 6 hours and 24 hours.
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pH measured for acid-base status.
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1 hour, 6 hours and 24 hours.
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Respiratory rate (Breath/minute)
Time Frame: At 1 hour, 6 hours and 24 hours.
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Rate of breathing per minute as documented in medical notes.
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At 1 hour, 6 hours and 24 hours.
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Heart rate (Beat/minute)
Time Frame: 1 hour, 6 hours and 24 hours.
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Heart rate per minute as documented in medical notes.
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1 hour, 6 hours and 24 hours.
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Mean arterial pressure in millimeters of mercury
Time Frame: 1 hour, 6 hours and 24 hours.
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Mean arterial pressure in millimeters of mercury as documented in medical notes
|
1 hour, 6 hours and 24 hours.
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Intubation rate
Time Frame: 1 hour, 6 hours and 24 hours.
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1 hour, 6 hours and 24 hours.
|
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ICU admission
Time Frame: From the date of randomization until the date of first documented admission to ICU, assessed up to 12 weeks.
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From the date of randomization until the date of first documented admission to ICU, assessed up to 12 weeks.
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In-hospital mortality
Time Frame: From the date of randomization until the date of death or hospital discharge, whichever came first, assessed up to 12 weeks.
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From the date of randomization until the date of death or hospital discharge, whichever came first, assessed up to 12 weeks.
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ICU length of stay
Time Frame: From the date of ICU admission until the date of last documented ICU discharge or date of death from any cause, whichever came first, assessed up to 12 weeks.
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From the date of ICU admission until the date of last documented ICU discharge or date of death from any cause, whichever came first, assessed up to 12 weeks.
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Hospital length of stay
Time Frame: From the date of randomization until hospital discharge or date of death from any cause, whichever came first, assessed up to 12 weeks.
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From the date of randomization until hospital discharge or date of death from any cause, whichever came first, assessed up to 12 weeks.
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Dyspnoea
Time Frame: 1 hour, 6 hours and 24 hours.
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Dyspnoea will be assessed assessment using a visual analogue scale (VAS), score range 0-10, higher values represent a better outcome)) if patient has capacity or the Likert scale (score range 1-5; higher values represent a better outcome) to be completed by the clinical team (doctor/nurse/physio) if the patient lacks capacity.
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1 hour, 6 hours and 24 hours.
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Patient comfort
Time Frame: 1 hour.
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Comfort will be assessed assessment using a visual analogue scale (VAS), score range 0-10, higher values represent a better outcome)) if patient has capacity or the Likert scale (score range 1-5; higher values represent a better outcome) to be completed by the clinical team (doctor/nurse/physio) if the patient lacks capacity.
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1 hour.
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Collaborators and Investigators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
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
- 19106MA-AS
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
product manufactured in and exported from the U.S.
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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