Lung Protective Ventilation in Pulmonary Thromboendarterectomy (PTE) Patients

NCT ID: NCT00747045

Last Updated: 2014-12-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

128 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-08-31

Study Completion Date

2011-03-31

Brief Summary

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Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by unresolved thromboemboli in the pulmonary arteries, which lead to pulmonary hypertension and, left untreated, right heart failure. This disease can be potentially cured by performing a pulmonary thromboendarterectomy (PTE) to remove the blood clots. The surgery is not without risk and the most worrisome complication is the development of a form of acute lung injury called reperfusion lung injury, which occurs in about 40 percent of patients.

The landmark publication of the ARDSNET study demonstrated that a low tidal volume strategy of mechanical ventilation, decreased morbidity and mortality in patients who had acute respiratory distress syndrome (ARDS). Since then there have been some studies examining the role of a low tidal volume strategy in all patients who are mechanically ventilated. Some studies have demonstrated a decreased incidence of acute lung injury while others have failed to do the same. In patients at high risk for developing acute lung injury, such as patients undergoing PTE, there may be a benefit to using low tidal volumes to reduce the incidence of reperfusion lung injury.

To assess the efficacy of a low tidal volume ventilation strategy in patients undergoing PTE, 134 patients will be randomized at the time of surgery to either low tidal volumes (6ml/kg of ideal body weight), or standard tidal volumes (10ml/kg of ideal body weight). Patients will be followed clinically to assess for the development of reperfusion lung injury. This will be defined as the development of hypoxemia (PaO2/FiO2 ratio less than 300) and chest infiltrates in the area of reperfused lung with no other identifiable etiology within the first 72 hours of surgery. Patients will also be assessed for other factors known to contribute to acute lung injury including: plateau pressures, peak inspiratory pressures, fluid balance, and number of transfusions received. Secondary endpoints of the study will be: time to successful spontaneous breathing trial, ventilator free days, ICU free days, hospital free days, and mortality.

Detailed Description

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Conditions

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Chronic Thromboembolic Pulmonary Hypertension Acute Lung Injury

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Low tidal volume

Tidal volume of 6 mL/Kg ideal body weight

Group Type EXPERIMENTAL

Ventilation Strategy

Intervention Type OTHER

Comparison of low vs standard tidal volumes in patients undergoing PTE

Usual care

Tidal volume of 10 mL/Kg ideal body weight

Group Type ACTIVE_COMPARATOR

Ventilation Strategy

Intervention Type OTHER

Comparison of low vs standard tidal volumes in patients undergoing PTE

Interventions

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Ventilation Strategy

Comparison of low vs standard tidal volumes in patients undergoing PTE

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age 18 years of age
* Evidence of CTEPH
* Acceptable surgical candidate

Exclusion Criteria

* BMI \> 40
* Patient undergoing lung biopsy or CABG at time of surgery
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of California, San Diego

OTHER

Sponsor Role lead

Responsible Party

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Kim Kerr

Clinical Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Kim M Kerr, MD

Role: PRINCIPAL_INVESTIGATOR

UCSD Medical Center

Locations

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UCSD - Thornton Hospital

La Jolla, California, United States

Site Status

Countries

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United States

References

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Bates DM, Fernandes TM, Duwe BV, King BO, Banks DA, Test VJ, Fedullo PF, Kim NH, Madani MM, Jamieson SW, Auger WR, Kerr KM. Efficacy of a Low-Tidal Volume Ventilation Strategy to Prevent Reperfusion Lung Injury after Pulmonary Thromboendarterectomy. Ann Am Thorac Soc. 2015 Oct;12(10):1520-7. doi: 10.1513/AnnalsATS.201503-142OC.

Reference Type DERIVED
PMID: 26241077 (View on PubMed)

Other Identifiers

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080721

Identifier Type: -

Identifier Source: org_study_id