- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06213168
Impact on Mortality of a Strategy Including Continuous Positive Airway Pressure Plus High Flow Nasal Cannula Oxygen Therapy Versus High Flow Nasal Cannula Oxygen Therapy Alone in Patients With de Novo Acute Hypoxemic Respiratory Failure: a Prospective, Randomized Controlled Trial. (HighCPAP)
Impact on Mortality of a Strategy Including Continuous Positive Airway Pressure Plus High Flow Nasal Cannula Oxygen Therapy Versus High Flow Nasal Cannula Oxygen Therapy Alone in Patients With de Novo Acute Hypoxemic Respiratory Failure: a Prospective, Randomized Controlled Trial
De novo hypoxemic acute respiratory failure (hARF) is one of the main causes of intensive care unit (ICU) admission. In de novo hARF, intubation is associated with a dramatic increase in mortality rate. Compared to standard oxygen, the use of high-flow oxygen nasal cannula (HFNC) might be beneficial to prevent intubation and mortality, although the results of trials and meta-analyses are conflicting. Even with HFNC, the intubation rate remains high. This is the reason why adjunctive therapies, administered in addition to HFNC are needed.
Continuous positive airway pressure (CPAP) is one of these adjunctive therapies. CPAP provides high level of positive end-expiratory pressure that ensures lung recruitment, but without adding inspiratory pressure support, which prevents ventilator induced lung injury. In addition, as opposed to pressure support, CPAP is well tolerated during long periods of time. Therefore, applying CPAP in addition to HFNC may reduce intubation rate and in turn mortality rate.
The present trial will evaluate the impact on mortality of a strategy including continuous positive airway pressure plus high flow nasal cannula oxygen therapy versus high flow nasal cannula oxygen therapy alone in patients with de novo acute hypoxemic respiratory failure: a Prospective, Randomized Controlled Trial
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Alexandre DEMOULE
- Phone Number: +33 (0)1 42 16 77 61
- Email: alexandre.demoule@aphp.fr
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adults (≥ 18 years old)
- Admitted in the ICU for ≤ 24 hours
De novo hARF defined by the three following criteria:
- Respiratory rate > 25 breaths/min or signs of respiratory distress such as labored breathing or paradoxical inspiration
- PaO2/FiO2 ≤ 200 mmHg under HFNC with flow ≥ 45 L/min, actual FiO2 being considered.
- Uni or bilateral pulmonary infiltrate on chest X-ray or CT scan
- Informed consent from the patient or her/his next of kin or another substitute decision maker, or inclusion procedure in emergency if the patient is unable to consent
Exclusion Criteria:
- Refusal of study participation by the patient or the proxy
- Anatomical factors precluding the use of a nasal cannula or CPAP
- Long term oxygen
- Home CPAP or NIV
- Hypercapnia indicating NIV (PaCO2 > 45 mmHg)
- Isolated cardiogenic pulmonary oedema indicating NIV
- Known pregnancy or breastfeeding
- Absence of coverage by the French statutory health care insurance system
- Surgery within the last 6 days
- Use of vasopressors (norepinephrine>0.3 mcg/kg/min)
- Glasgow coma scale < 13
- Urgent need for endotracheal intubation
- Patients at an end-of-life stage receiving compational oxygenation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: HFNC
Patients assigned to the control group will be continuously treated by HFNC.
HFNC will be initiated within one hour following randomization.
|
Patients assigned to the control group will be continuously treated by HFNC.
HFNC will be initiated within one hour following randomization
Other Names:
|
Experimental: HFNC with CPAP
Patients assigned to the intervention group will receive high flow nasal oxygen plus CPAP sessions
|
Patients assigned to the control group will be continuously treated by HFNC.
HFNC will be initiated within one hour following randomization
Other Names:
Patients assigned to the intervention group will receive high flow nasal oxygen plus CPAP sessions
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mortality
Time Frame: 90 days
|
Time to death within the 90 days after randomization
|
90 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time from randomization to intubation.
Time Frame: 28 days
|
28 days
|
|
Intensity of dyspnea until intubation as assessed by a visual analogic scale from zero (no dyspnea) to 100 (maximum possible dyspnea).
Time Frame: 2, 6, 12 and 24 hours
|
2, 6, 12 and 24 hours
|
|
Respiratory rate
Time Frame: 6, 12 and 24 hours
|
6, 12 and 24 hours
|
|
ROX index
Time Frame: 6, 12 and 24 hours
|
6, 12 and 24 hours
|
|
Evaluation of intolerance to oxygenation technique until intubation
Time Frame: 12 and 24 hours
|
evaluation based on the following physical criteria: eyes dryness, nose dryness and/or feeling of gastric distention
|
12 and 24 hours
|
Discomfort associated with the interface as assessed by a visual analogic scale from zero (no discomfort) to 100 (maximum possible discomfort).
Time Frame: 12 and 24 hours
|
12 and 24 hours
|
|
Level of oxygenation assessed by blood gas that will be sampled on the request of the physician in charge (clinical purpose only).
Time Frame: First 24 hours or until intubation
|
First 24 hours or until intubation
|
|
Use of NIV for one of the following predefined indication criteria.
Time Frame: through study completion
|
|
through study completion
|
Death within the ICU
Time Frame: through patient participation period,180 days maximum
|
through patient participation period,180 days maximum
|
|
Time to death
Time Frame: through patient participation period, an average of 180 days maximum
|
through patient participation period, an average of 180 days maximum
|
|
Death within the hospital and time to death.
Time Frame: through patient participation period,180 days maximum
|
through patient participation period,180 days maximum
|
|
Number of invasive ventilation-free days at 28 days defined as days alive and without intubation.
Time Frame: Between day 1 and day 28
|
One point will be given for each day during the measurement period, i.e. from the first day of randomization to day 28 that patients will be both alive and free of invasive mechanical ventilation.
Zero value will be given for patients who die before day 28.
|
Between day 1 and day 28
|
Number of HFNC-free days at 28 days defined as days non-intubated, alive and without HFNC.
Time Frame: Between day 1 and day 28.
|
One point will be given for each day during the measurement period, i.e. from the first day of randomization to day 28 that patients will be both alive and free of HFNO and invasive mechanical ventilation.
Zero value will be given for patients who die or are intubated before day 28.
|
Between day 1 and day 28.
|
ICU length of stay.
Time Frame: through patient participation period,180 days maximum
|
through patient participation period,180 days maximum
|
|
Hospital length of stay.
Time Frame: through patient participation period,180 days maximum
|
through patient participation period,180 days maximum
|
|
Occurrence of any adverse event during the ICU stay, with a particular focus on hospital or ventilator associated pneumonia, non-respiratory infections, cardiac arrhythmia, and cardiac arrest.
Time Frame: through patient participation period,180 days maximum
|
through patient participation period,180 days maximum
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
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
- APHP220813
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.
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