Clinical trial NCT04349332: Early Extubation for Patients With Acute Hypoxemic Respiratory Failure
Official title: Early Extubation for Patients With Acute Hypoxemic Respiratory Failure
Study type: INTERVENTIONAL
Overall status: WITHDRAWN
Phase: NA
Conditions: Mechanical Ventilation
Corona Virus Infection
Keywords: helmet interface NIV
early extubation
acute hypoxemic respiratory failure
Lead sponsor: University of Chicago
Sponsor class: OTHER
First posted: 2020-04-16
Enrollment: 0
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: randomized trial
Primary purpose: SUPPORTIVE_CARE

Brief summary: The objective of the study is to evaluate the efficacy of helmet NIV in reducing the duration of invasive mechanical ventilation in order to minimize ventilator needs during the COVID-19 pandemic.

Detailed description: Single center randomized clinical trial investigating the efficacy of helmet NIV used for early liberation from mechanical ventilation in patients with acute hypoxemic respiratory failure.

Intervention: Helmet group Patients randomized to the intervention group will be extubated to helmet NIV without a spontaneous breathing trial. The helmet will be connected to oxygen and room air flow meter to deliver a minimum of 60L of fresh gas flow and a PEEP valve. The PEEP will be increased using a PEEP valve in increments of 2-3 cmH20 to improve peripheral oxygen saturation of at least 90% at an inspired oxygen requirement (FiO2) of ≤ 60%.14 After application of the helmet, arterial blood gas sampling will be utilized to follow gas-exchange; this is a part of usual care for the management of patients with acute hypoxemic respiratory failure. Noninvasive support will be reduced progressively in accordance to clinical improvement and will be discontinued if patient maintains respiratory rate \<30breaths/min and PaO2 \>75mm Hg with FiO2 0.5 without ventilatory support. If endotracheal intubation is required, the helmet will be removed and the patient will be intubated without delay.

Control: Usual Care Patient randomized to the control group will continue invasive mechanical ventilation until the following weaning criteria are met:15 Resolution or improvement of the condition leading to intubation Hemodynamic stability, defined as systolic blood pressure between 90 and 160 mm Hg and heart rate less than 140/min without vasopressors or with low doses of vasopressors Glasgow Coma Scale score of 13 or greater Respiratory stability (oxygen saturation \>90% with fraction of inspired oxygen \[Fio2\] ≤0.4, respiratory rate \<35/min, Noncopious secretions (\<3 aspirations in the last 8 hours).

Once weaning criteria are met, patients will undergo a spontaneous breathing trial for 30 minutes on pressure support mode. Criteria for failure to tolerate the SBT were agitation, anxiety, low level of consciousness (Glasgow Coma Scale score \<13), respiratory rate higher than 35/min and/or use of accessory muscles, oxygen saturation by pulse oximetry less than 90% with Fio2 higher than 0.5, heart rate higher than 140/min or greater than a 20% increase from baseline, systolic blood pressure lower than 90 mm Hg, or development of arrhythmia. If the spontaneous breathing trial is successful, then the patient will be extubated.

Subjects will be followed for long term followup at 90 day and 1year mortality

Eligibility criteria: Inclusion Criteria:

Age ≥18 years old on mechanical ventilation for at least 48 hours Positive End Expiratory Pressure (PEEP) level between 8 to 13cm H20 The ratio between the partial pressure of oxygen and fraction of inspired oxygen (PaO2/FiO2) between 150 and 300 mmHg with FiO2≤0.6 pH≥7.25 Respiratory rate (RR)≤30/min Adequate gag and cough reflex Ability to spontaneously breathe

Exclusion Criteria:

Hemodynamic instability (Systolic blood pressure \<90 or requiring \>2 vasoactive agents) Tracheostomy Upper airway obstruction Pregnancy Elevated intracranial pressure Upper airway obstruction Glasgow coma scale ≤ 8 Patients who refuse to undergo endotracheal intubation, whatever the initial therapeutic approach

Primary outcomes:
measure: ventilator days
timeFrame: up to 4 weeks
Secondary outcomes:
measure: Intensive care unit (ICU) length of stay
timeFrame: up to 6 weeks
measure: need for re-intubation
timeFrame: up to 6 weeks
Other outcomes:
measure: hospital length of stay
timeFrame: up to 6 weeks
measure: hospital mortality
timeFrame: up to 6 weeks
measure: long term mortality
timeFrame: up to 1 year
measure: ICU related complications
timeFrame: up to 6 weeks
measure: discharge location
timeFrame: up to 90 days
measure: health care utilization
timeFrame: up to 6 weeks
measure: diaphragm ultrasound thickness
timeFrame: up to 6 weeks
measure: diaphragm thickening fraction
timeFrame: up to 6 weeks
Locations:
city: Chicago
country: United States
facility: University of Chicago Medical Center
state: Illinois
Study officials:
References: