- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04708509
Extubation Advisor: Initial Implementation and Evaluation of a Novel Extubation Clinical Decision Support Tool
September 22, 2022 updated by: Ottawa Hospital Research Institute
Expeditious, safe extubation is vitally important in the care of Intensive Care Unit (ICU) patients, as prolonged mechanical ventilation harms patients and failed extubation (i.e.
re-intubation within 48 hrs) is associated with increased morbidity, mortality and costs.
The urgent need to improve extubation failure is further highlighted by current observations suggesting that COVID-19 patients are at increased risk of both early and late extubation failure.
The investigators previously found that decreased respiratory rate variability (indicative of reduced adaptability and/or increased stress) during Spontaneous Breathing Trials (SBTs) predicted extubation failure and outperformed the best available predictive indices.
Combining this predictive analytic with standardized extubation readiness checklists and risk mitigation strategies, the investigators created the Extubation Advisor (EA).
The investigators recently completed a single-center phase I mixed methods observational study (n=117) wherein there was demonstrated technical feasibility (i.e.
ability to generate 92% EA of reports) and clinician acceptance of the EA tool.
In the current open-label, multi-center interventional phase I study, the investigators will assess the feasibility and initial perceptions of EA implementation in the intensive care unit by (1) evaluating the feasibility of patient enrolment, data collection, and EA report generation, and (2) performing a mixed-methods analysis of critical care physician and respiratory therapist perceptions of EA.
Findings from this study will inform a future randomized controlled trial assessing EA outcomes compared to standard of care, with the intent of aiding bedside decision-making, enhancing care delivery, and improving outcomes in critically ill patients with and without COVID-19.
Study Overview
Study Type
Interventional
Enrollment (Anticipated)
72
Phase
- Phase 1
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Andrew JE Seely, MD, PhD, FRCSC
- Phone Number: 74052 613-737-8899
- Email: aseely@toh.ca
Study Locations
-
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Ontario
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Ottawa, Ontario, Canada, K1H 8L6
- Recruiting
- The Ottawa Hospital, General Campus
-
Contact:
- Andrew Seely, MD
- Phone Number: 75052 613-737-8899
- Email: aseely@ottawahospital.on.ca
-
Principal Investigator:
- Andrew JE Seely, MD PhD FRCSC
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Principal Investigator:
- Karen Burns, MD FRCPC MSc
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Sub-Investigator:
- Jamie Brehaut, PhD
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Sub-Investigator:
- Christophe Herry, PhD
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Sub-Investigator:
- Bram Rochwerg, MD MSc FRCPC
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Sub-Investigator:
- Aimee Sarti, MD FRCPC
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- In the Intensive Care Unit (ICU)
- Able to provide informed consent (through a surrogate)
- Invasive mechanical ventilation for > 48 hours
- Ready for spontaneous breathing test (SBT) for assessment for extubation
- At least partial reversal of the condition precipitating mechanical ventilation
- Stabilization of other organ systems
- Toleration of pressure support ventilation less than or equal to 14 cm H2O, (oxygen saturation (SpO2) greater than or equal to 90% with fraction of inspired oxygen (FiO2) less than or equal to 40% and positive end-expiry pressure (PEEP) less than or equal to 10cm H2O)
- Hemodynamic stability (low - phenylephrine less than 50 ug/min; norepinephrine less than 5 ug/min; dobutamine less than 5 ug/kg/min; milrinone less than 0.4 ug/kg/min - or no vasopressors)
- Stable neurological status (no deterioration in Glasgow coma score during prior 24 hours and, if measured, intracranial pressure (ICP) less than 20 mmHg)
- Intact airway reflexes (adequate cough with suctioning and a gag reflex)
- Normal sinus rhythm at the time of the SBT (no pacemaker)
Exclusion Criteria:
- Order not to re-intubate should the patient fail extubation
- Anticipated withdrawal of life support
- Known or suspected severe weakness (myopathy, neuropathy, or quadriplegia)
- Tracheostomy
- Prior extubation during current ICU stay
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention Arm
Wave form data from participants' spontaneous breathing trials (SBT) will be analyzed using Extubation Advisor (EA) to generate an EA report that provides clinical decision support regarding extubation.
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Participants undergoing a Spontaneous Breathing Trial (SBT) to assess readiness for extubation will be connected to a portable monitor displaying ECG, capnography, and other waveforms.
This monitor will also be connected to a laptop containing the Extubation Advisor (EA) software.
During the SBT, relevant patient information will be entered into the EA application and the EA application will record waveform data.
When the SBT is complete, the EA application will analyze the waveform and patient data to generate a score summarizing the risk of extubation failure.
A report will be generated and provided to the respiratory therapist and attending physician to help determine whether to proceed with extubation or not.
Patients will be followed for 72 hours after extubation, when the clinical outcome case report form will be completed.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evaluate feasibility of enrolling and consenting greater than 50% of eligible patients
Time Frame: Upon study completion, 4 months after study initiation
|
Feasibility of patient enrolment and consent will be evaluated by determining if greater than 50% of eligible patients are enrolled and consented
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Upon study completion, 4 months after study initiation
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Evaluate feasibility of capturing greater than 75% of wave form data
Time Frame: Upon study completion, 4 months after study initiation
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Feasibility of wave form data capture will be evaluated by determining if greater than 75% of the time, wave form data is captured
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Upon study completion, 4 months after study initiation
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Evaluate feasibility of entering greater than 90% of participant clinical data into the Extubation Advisor tool
Time Frame: Upon study completion, 4 months after study initiation
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Feasibility of participant clinical data entry will be evaluated by determining if greater than 90% of the time, participant clinical data is fully entered into the Extubation Advisor tool
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Upon study completion, 4 months after study initiation
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Evaluate feasibility of generating and delivering greater than 80% of Extubation Advisor reports to the attending physician
Time Frame: Upon study completion, 4 months after study initiation
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Feasibility of Extubation Advisor report generation will be evaluated by determining if greater than 80% of the time, an extubation report is successfully generated and delivered to the attending physician
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Upon study completion, 4 months after study initiation
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Evaluate opinions of Physicians and Respiratory Therapists regarding Extubation Advisor
Time Frame: Upon study completion, 4 months after study initiation
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Usability, perceived value, identified behaviours, perceived barriers and drivers, and perceived impact will be assessed through interviews with respiratory therapists and attending physicians
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Upon study completion, 4 months after study initiation
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evaluate feasibility of completing greater than 90% of clinical CRFs
Time Frame: Upon study completion, 4 months after study initiation
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Feasibility of completing the clinical case report forms will be evaluated by determining if greater than 90% of the time, clinical CRFs are complete
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Upon study completion, 4 months after study initiation
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Andrew JE Seely, MD, PhD, FRCSC, The Ottawa Hospital
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 4, 2021
Primary Completion (Anticipated)
January 1, 2023
Study Completion (Anticipated)
February 1, 2023
Study Registration Dates
First Submitted
January 11, 2021
First Submitted That Met QC Criteria
January 11, 2021
First Posted (Actual)
January 14, 2021
Study Record Updates
Last Update Posted (Actual)
September 23, 2022
Last Update Submitted That Met QC Criteria
September 22, 2022
Last Verified
September 1, 2022
More Information
Terms related to this study
Other Study ID Numbers
- 2681
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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