Study of Body Positions in Unconsciousness
8 de outubro de 2020 atualizado por: University of Oxford
A Randomised Controlled Study of the Use of Recovery Positions for Comatose Patients in a Resource Limited Setting
In resource limited settings, access to one-on-one nursing care and airway protection by intubation may be unavailable.
Patients with coma but adequate oxygenation are frequently cared for on medical wards, and nursed by their family members.
The investigators previously audited the use of the recovery position in patients with cerebral malaria and found that its usage was greatly increased by an educational intervention aimed at patient's caregivers.
A trend to reduction in coma duration and aspiration pneumonia was also found.
Since there is no evidence that placing comatose, non-intubated patients in a recovery position improves outcome, the investigators plan to conduct a randomised controlled study comparing standard care with an educational intervention targeting patients' relatives, teaching them to maintain their relative in one of two different recovery positions.
With the preliminary efficacy and safety data and feedback that this study will provide, the investigators would then move to conduct a large multicenter study powered to detect a difference in mortality.
Visão geral do estudo
Status
Concluído
Condições
Intervenção / Tratamento
Descrição detalhada
Methods:
In this prospective, three-armed randomised controlled study, patients admitted to the adult medical wards of Chittagong Medical College Hospital with acute onset of reduced consciousness (Glasgow Coma Scale (GCS) <12 for less than 5 days) will be randomised 1:1:1 to one of three arms; standard care (no intervention) or an educational intervention directing placement into one of two recovery positions.
The educational intervention will occur following randomisation and on daily follow-up until recovery from deep coma or death. For patients in the intervention arms, the patients' relatives will be instructed on how to maintain their patient in the recovery position, and an educational poster will be attached to their bed.
Enrolled subjects will be observed 3 times a day until discharge for body position and vital signs including GCS, heart rate, respiratory rate and oxygen saturation.
The primary outcome will be the risk of (hazard ratio) aspiration pneumonia and pneumonitis. The secondary outcome measures will include time to hypoxia, death and coma recovery time. Pulmonary complications will be defined clinically and radiologically. The primary comparison between groups will be the standard care group versus both recovery positions combined. Analysis will be by intention to treat.
Tipo de estudo
Intervencional
Inscrição (Real)
1540
Estágio
- Não aplicável
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Locais de estudo
-
-
-
Chittagong, Bangladesh
- Chittagong medical College hospital
-
-
Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
18 anos e mais velhos (Adulto, Adulto mais velho)
Aceita Voluntários Saudáveis
Não
Gêneros Elegíveis para o Estudo
Tudo
Descrição
Inclusion Criteria:
- Male or female admitted to the medical wards at CMCH
- Current GCS < 12
- Less than 5 day history of reduced consciousness
- Written informed consent obtained through an adult (≥18 years) relative or parent/guardian
Exclusion Criteria:
- Suspected head or spinal injury/trauma requiring appropriate immobilisation and stabilization
- Patient physically restrained by ward staff due to agitation
- Unsuitability for lateral positioning e.g. due to burns on lateral aspects, femoral vascular catheter
- Requirement for nursing in an upright position e.g. due to respiratory insufficiency
- Known or suspected pregnancy
- Intubation
- Patient or family member previously enrolled in this study.
- Consent refused, or no adult (≥18 years) relative or parent/guardian present to give consent
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Cuidados de suporte
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Sem intervenção: Control
Randomized to standard care (control group) - observations only
|
|
|
Experimental: UKRC 1997
Randomized to modified UKRC 1997 - Intervention and Observations
|
Educational poster intervention indicating the modified UKRC 1997 recovery position
|
|
Experimental: UKRC 2010
Randomized to modified UKRC 2010 - Intervention and Observations
|
Educational poster intervention indicating the modified UKRC 2010 recovery position
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Prazo |
|---|---|
|
Composite of aspiration pneumonitis or pneumonia
Prazo: 48 hours after GCS13
|
48 hours after GCS13
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Proportion of patients developing hypoxia
Prazo: 48 hours after GCS13,
|
48 hours after GCS13,
|
|
|
Development of pneumonia or pneumonitis, assessed individually
Prazo: 48 hours after GCS13
|
48 hours after GCS13
|
|
|
Mortality
Prazo: 7 days post discharge/last follow-up
|
7 days post discharge/last follow-up
|
|
|
Time to mortality
Prazo: 7 days post discharge/last follow-up
|
7 days post discharge/last follow-up
|
|
|
Coma recovery time, defined as time to GCS 15
Prazo: during hospitalization (defined as time to GCS 15), expected less than 4 weeks
|
during hospitalization (defined as time to GCS 15), expected less than 4 weeks
|
|
|
The number of documented episodes of hypoxia
Prazo: 48 hours after GCS 13
|
48 hours after GCS 13
|
|
|
Percentage of observations in the recovery position
Prazo: whilst GCS<12, expected less than 2 months
|
whilst GCS<12, expected less than 2 months
|
|
|
Modified Rankin scale
Prazo: on discharge, expected less than 2 months
|
on discharge, expected less than 2 months
|
|
|
Composite of pressure sore, venous thrombosis, arm or leg peripheral nerve or joint injury
Prazo: whilst GCS<12, expected less than 2 months
|
whilst GCS<12, expected less than 2 months
|
|
|
Proportion of patients developing a pressure sore
Prazo: whilst GCS<12, expected less than 2 months
|
whilst GCS<12, expected less than 2 months
|
|
|
Proportion of patients developing a venous thrombosis,
Prazo: whilst GCS<12, expected less than 2 months
|
whilst GCS<12, expected less than 2 months
|
|
|
Proportion of patients developing a new arm or leg peripheral nerve injury
Prazo: during hospitalization, expected less than 2 months
|
during hospitalization, expected less than 2 months
|
|
|
Proportion of patients developing a new arm or leg joint injury
Prazo: during hospitalization, expected less than 2 months
|
during hospitalization, expected less than 2 months
|
|
|
Trends in Blood presure
Prazo: during hospitalization, expected less than 2 months
|
measure Systolic and diastolic blood pressure levels
|
during hospitalization, expected less than 2 months
|
|
Trends in heart rate
Prazo: during hospitalization, expected less than 2 months
|
during hospitalization, expected less than 2 months
|
|
|
Proportion of patients developing peripheral venous cannula function
Prazo: whilst GCS<12, expected less than 2 months
|
whilst GCS<12, expected less than 2 months
|
|
|
time to hypoxia
Prazo: 48 hours after GCS13, expected less than 2 months
|
48 hours after GCS13, expected less than 2 months
|
Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Hugh Kingston, Dr., Mahidol Oxford Tropical Medicine Research Unit
Publicações e links úteis
A pessoa responsável por inserir informações sobre o estudo fornece voluntariamente essas publicações. Estes podem ser sobre qualquer coisa relacionada ao estudo.
Publicações Gerais
- American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416. doi: 10.1164/rccm.200405-644ST. No abstract available.
- Warner MA, Warner ME, Weber JG. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology. 1993 Jan;78(1):56-62. doi: 10.1097/00000542-199301000-00010.
- Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, Lerner EB, Rea TD, Sayre MR, Swor RA. Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S685-705. doi: 10.1161/CIRCULATIONAHA.110.970939. Erratum In: Circulation. 2011 Oct 11;124(15):e402.
- Stroud M, Duncan H, Nightingale J; British Society of Gastroenterology. Guidelines for enteral feeding in adult hospital patients. Gut. 2003 Dec;52 Suppl 7(Suppl 7):vii1-vii12. doi: 10.1136/gut.52.suppl_7.vii1. No abstract available.
- Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castren M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, Sandroni C. European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2010 Oct;81(10):1277-92. doi: 10.1016/j.resuscitation.2010.08.009. No abstract available.
- Maude RJ, Hoque G, Hasan MU, Sayeed A, Akter S, Samad R, Alam B, Yunus EB, Rahman R, Rahman W, Chowdhury R, Seal T, Charunwatthana P, Chang CC, White NJ, Faiz MA, Day NP, Dondorp AM, Hossain A. Timing of enteral feeding in cerebral malaria in resource-poor settings: a randomized trial. PLoS One. 2011;6(11):e27273. doi: 10.1371/journal.pone.0027273. Epub 2011 Nov 16.
- Resuscitation Council (UK) Resuscitation 2010 Guidelines Edited by Jerry P. Nolan ISBN 978-1-903812-21-1
- Leopold SJ, personal communication, November 2013.
- Huxley EJ, Viroslav J, Gray WR, Pierce AK. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med. 1978 Apr;64(4):564-8. doi: 10.1016/0002-9343(78)90574-0.
- Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet. 1996 Jul 13;348(9020):123-4. doi: 10.1016/s0140-6736(05)64630-2. No abstract available.
- Markenson D, Ferguson JD, Chameides L, Cassan P, Chung KL, Epstein JL, Gonzales L, Hazinski MF, Herrington RA, Pellegrino JL, Ratcliff N, Singer AJ; First Aid Chapter Collaborators. Part 13: First aid: 2010 American Heart Association and American Red Cross International Consensus on First Aid Science With Treatment Recommendations. Circulation. 2010 Oct 19;122(16 Suppl 2):S582-605. doi: 10.1161/CIRCULATIONAHA.110.971168. No abstract available. Erratum In: Circulation. 2010 Nov 23;122(21):2227. Circulation. 2012 Apr 17;125(15):585.
- Adnet F, Borron SW, Finot MA, Minadeo J, Baud FJ. Relation of body position at the time of discovery with suspected aspiration pneumonia in poisoned comatose patients. Crit Care Med. 1999 Apr;27(4):745-8. doi: 10.1097/00003246-199904000-00028.
- Turner S, Turner I, Chapman D, Howard P, Champion P, Hatfield J, James A, Marshall S, Barber S. A comparative study of the 1992 and 1997 recovery positions for use in the UK. Resuscitation. 1998 Dec;39(3):153-60. doi: 10.1016/s0300-9572(98)00144-0.
- Fulstow R, Smith GB. The new recovery position, a cautionary tale. Resuscitation. 1993 Aug;26(1):89-91. doi: 10.1016/0300-9572(93)90167-o.
- Kumar P, Touquet R. Perils of the recovery position: neurapraxia of radial and common peroneal nerve. J Accid Emerg Med. 1996 Jan;13(1):69-70. doi: 10.1136/emj.13.1.69-c. No abstract available.
- Rathgeber J, Panzer W, Gunther U, Scholz M, Hoeft A, Bahr J, Kettler D. Influence of different types of recovery positions on perfusion indices of the forearm. Resuscitation. 1996 Jul;32(1):13-7. doi: 10.1016/0300-9572(96)00952-5.
- Doxey J. Comparing 1997 Resuscitation Council (UK) recovery position with recovery position of 1992 European Resuscitation Council guidelines: a user's perspective. Resuscitation. 1998 Dec;39(3):161-9. doi: 10.1016/s0300-9572(98)00142-7.
- The 1997 Resuscitation Guidelines for use in the United Kingdom April 1997. Resuscitation Council (UK) Publication.
- Handley AJ, Becker LB, Allen M, van Drenth A, Kramer EB, Montgomery WH. Single rescuer adult basic life support. An advisory statement from the Basic Life Support Working Group of the International Liaison Committee on Resuscitation (ILCOR). Resuscitation. 1997 Apr;34(2):101-8. doi: 10.1016/s0300-9572(97)01099-x. No abstract available.
- Handley AJ. Resuscitation. Resuscitation Council (UK) wants everyone who uses new recovery position to report experiences. BMJ. 1997 Nov 15;315(7118):1308. No abstract available.
- Guidelines for the Treatment of Malaria. 2nd edition. Geneva: World Health Organization; 2010. Available from http://www.ncbi.nlm.nih.gov/books/NBK254223/
- Bollig G, Wahl HA, Svendsen MV. Primary school children are able to perform basic life-saving first aid measures. Resuscitation. 2009 Jun;80(6):689-92. doi: 10.1016/j.resuscitation.2009.03.012. Epub 2009 Apr 21.
- Sakai T, Planinsic RM, Quinlan JJ, Handley LJ, Kim TY, Hilmi IA. The incidence and outcome of perioperative pulmonary aspiration in a university hospital: a 4-year retrospective analysis. Anesth Analg. 2006 Oct;103(4):941-7. doi: 10.1213/01.ane.0000237296.57941.e7.
- Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML, Wani M, Woodhead MA; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64 Suppl 3:iii1-55. doi: 10.1136/thx.2009.121434. No abstract available.
- Dalhoff K, Ewig S; Gideline Development Group; Abele-Horn M, Andreas S, Bauer TT, von Baum H, Deja M, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Hoffken G, Kern W, Kramme E, Lange C, Lorenz J, Mayer K, Nachtigall I, Pletz M, Rohde G, Rosseau S, Schaaf B, Schaumann R, Schreiter D, Schutte H, Seifert H, Sitter H, Spies C, Welte T. Adult patients with nosocomial pneumonia: epidemiology, diagnosis, and treatment. Dtsch Arztebl Int. 2013 Sep;110(38):634-40. doi: 10.3238/arztebl.2013.0634. Epub 2013 Sep 20.
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo (Real)
23 de agosto de 2014
Conclusão Primária (Real)
21 de março de 2020
Conclusão do estudo (Real)
21 de março de 2020
Datas de inscrição no estudo
Enviado pela primeira vez
12 de janeiro de 2015
Enviado pela primeira vez que atendeu aos critérios de CQ
27 de abril de 2015
Primeira postagem (Estimativa)
28 de abril de 2015
Atualizações de registro de estudo
Última Atualização Postada (Real)
12 de outubro de 2020
Última atualização enviada que atendeu aos critérios de controle de qualidade
8 de outubro de 2020
Última verificação
1 de outubro de 2020
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Outros números de identificação do estudo
- BAKMAL1405
Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .
Ensaios clínicos em Coma
-
Centre Hospitalier Universitaire de BesanconRescindido
-
Hospices Civils de LyonAinda não está recrutando
-
University Hospital, ToulouseConcluído
-
RenJi HospitalXiangya Hospital of Central South University; Beijing Tiantan Hospital; The General... e outros colaboradoresAinda não está recrutandoLesões Cerebrais Traumáticas | ComaChina
-
Institut National de la Santé Et de la Recherche...Recrutamento
-
Akdeniz UniversityAinda não está recrutandoCárie de enfermagem | Trauma na cabeça | Coma Traumático
-
University Hospital, BordeauxInria, the French National Institute for computer science and applied mathematicsAinda não está recrutandoCuidados intensivos | Prognóstico | Em comaFrança
-
Markey OlsonInscrevendo-se por convite
-
Cairo UniversityHelwan University; Prince Sattam Bin Abdulaziz UniversityConcluídoComa, traumático | Pacientes com Lesão Cerebral TraumáticaEgito
-
Dokuz Eylul UniversityDesconhecido
Ensaios clínicos em Educational Intervention UKRC 1997
-
Cairo UniversityConcluídoEsclerose Múltipla Remitente-RecorrenteEgito