Detailed statistical analysis plan for the pulmonary protection trial

Katrine B Buggeskov, Janus C Jakobsen, Niels H Secher, Thomas Jonassen, Lars W Andersen, Daniel A Steinbrüchel, Jørn Wetterslev, Katrine B Buggeskov, Janus C Jakobsen, Niels H Secher, Thomas Jonassen, Lars W Andersen, Daniel A Steinbrüchel, Jørn Wetterslev

Abstract

Background: Pulmonary dysfunction complicates cardiac surgery that includes cardiopulmonary bypass. The pulmonary protection trial evaluates effect of pulmonary perfusion on pulmonary function in patients suffering from chronic obstructive pulmonary disease. This paper presents the statistical plan for the main publication to avoid risk of outcome reporting bias, selective reporting, and data-driven results as an update to the published design and method for the trial.

Results: The pulmonary protection trial is a randomized, parallel group clinical trial that assesses the effect of pulmonary perfusion with oxygenated blood or Custodiol™ HTK (histidine-tryptophan-ketoglutarate) solution versus no pulmonary perfusion in 90 chronic obstructive pulmonary disease patients. Patients, the statistician, and the conclusion drawers are blinded to intervention allocation. The primary outcome is the oxygenation index from 10 to 15 minutes after the end of cardiopulmonary bypass until 24 hours thereafter. Secondary outcome measures are oral tracheal intubation time, days alive outside the intensive care unit, days alive outside the hospital, and 30- and 90-day mortality, and one or more of the following selected serious adverse events: pneumothorax or pleural effusion requiring drainage, major bleeding, reoperation, severe infection, cerebral event, hyperkaliemia, acute myocardial infarction, cardiac arrhythmia, renal replacement therapy, and readmission for a respiratory-related problem.

Conclusions: The pulmonary protection trial investigates the effect of pulmonary perfusion during cardiopulmonary bypass in chronic obstructive pulmonary disease patients. A preserved oxygenation index following pulmonary perfusion may indicate an effect and inspire to a multicenter confirmatory trial to assess a more clinically relevant outcome.

Trial registration: ClinicalTrials.gov identifier: NCT01614951, registered on 6 June 2012.

Figures

Figure 1
Figure 1
CONSORT flow diagram. ITT, intension-to-treat; OI, oxygenation index.

References

    1. Buggeskov KB, Wetterslev J, Secher NH, Andersen LW, Jonassen T, Steinbrüchel DA. Pulmonary perfusion with oxygenated blood or custodiol HTK solution during cardiac surgery for postoperative pulmonary function in COPD patients: a trial protocol for the randomized, clinical, parallel group, assessor and data analyst blinded Pulmonary Protection Trial. Trials. 2013;14:30. doi: 10.1186/1745-6215-14-30.
    1. Dwan K, Gamble C, Williamson PR, Altman DG. Reporting of clinical trials: a review of research funders’ guidelines. Trials. 2008;9:66. doi: 10.1186/1745-6215-9-66.
    1. Thomas L, Peterson ED. The value of statistical analysis plans in observational research: defining high-quality research from the start. JAMA J Am Med Assoc. 2012;308:773–774. doi: 10.1001/jama.2012.9502.
    1. Gabriel SE, Normand S-LT. Getting the methods right–the foundation of patient-centered outcomes research. N Engl J Med. 2012;367:787–790. doi: 10.1056/NEJMp1207437.
    1. Jakobsen JC, Gluud C, Winkel P, Lange T, Wetterslev J. The thresholds for statistical and clinical significance - a five-step procedure for evaluation of intervention effects in randomized clinical trials. BMC Med Res Methodol. 2014;14:34. doi: 10.1186/1471-2288-14-34.
    1. Dmitrienko A, Soulakova JN, Millen BA. Three methods for constructing parallel gatekeeping procedures in clinical trials. J Biopharm Stat. 2011;21:768–786. doi: 10.1080/10543406.2011.554130.
    1. Santini F, Onorati F, Telesca M, Patelli F, Berton G, Franchi G, Faggian G, Mazzucco A. Pulsatile pulmonary perfusion with oxygenated blood ameliorates pulmonary hemodynamic and respiratory indices in low-risk coronary artery bypass patients. Eur J Cardio-Thorac Surg. 2011;40:794–803. doi: 10.1016/j.ejcts.2011.03.046.
    1. Li J, Liu Y, Liu J-P, Li X. Pulmonary artery perfusion with HTK solution prevents lung injury in infants after cardiopulmonary bypass. Chin Med J (Engl) 2010;123:2645–2650.
    1. Abraha I, Montedori A. Modified intention to treat reporting in randomized controlled trials: systematic review. BMJ. 2010;340:c2697. doi: 10.1136/bmj.c2697.
    1. Kahan BC, Morris TP. Reporting and analysis of trials using stratified randomization in leading medical journals: review and reanalysis. BMJ. 2012;345:e5840. doi: 10.1136/bmj.e5840.
    1. Chakraborty H, Gu H. A Mixed Model Approach for Intent-to-Treat Analysis in Longitudinal Clinical Trials With Missing Values. Psychiatry Res. 2004;129(2):209–15. doi: 10.1016/j.psychres.2004.08.001.
    1. Mallinckrodt CH, Lin Q, Molenberghs M. A structured framework for assessing sensitivity to missing data assumptions in longitudinal clinical trials. Pharm Stat. 2013;12:1–6. doi: 10.1002/pst.1547.
    1. Little RJA. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988;83:1198. doi: 10.1080/01621459.1988.10478722.
    1. Juul S. An Introduction to Stata for Health Researchers. 3. College Station, Texas: Stata Press; 2010.
    1. Oliveira AG. Biostatistics Decoded. 1. Chichester, West Sussex: Wiley; 2013.
    1. Schafer JL. Multiple imputation: a primer. Stat Methods Med Res. 1999;8:3–15. doi: 10.1191/096228099671525676.
    1. Vickers AJ, Altman DG. Statistics notes: missing outcomes in randomized trials. BMJ. 2013;346:f3438. doi: 10.1136/bmj.f3438.
    1. Moher D, Schulz KF, Altman D, CONSORT Group (Consolidated Standards of Reporting Trials) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA J Am Med Assoc. 2001;285:1987–1991. doi: 10.1001/jama.285.15.1987.
    1. Qu Y, Zhao YD, Rahardja D. Wilcoxon-Mann–Whitney test: stratify or not? J Biopharm Stat. 2008;18:1103–1111. doi: 10.1080/10543400802369103.
    1. Waldau T, Larsen VH, Bonde J. Evaluation of five oxygen delivery devices in spontaneously breathing subjects by oxygraphy. Anaesthesia. 1998;53:256–263. doi: 10.1046/j.1365-2044.1998.00318.x.

Source: PubMed

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