Weaning From Noninvasive Ventilation

NCT ID: NCT02845076

Last Updated: 2020-07-10

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

197 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-09-30

Study Completion Date

2020-03-31

Brief Summary

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Noninvasive ventilation (NIV) weaning strategies differ considerably from one another. These strategies have yet not been compared to each other. Therefore, the investigators planned to perform a prospective, randomized, pilot study involving hypercapnic acute respiratory failure patients ready to be weaned off from NIV. The investigators are going to compare the success rate of NIV weaning and the duration of NIV after randomization between 3 NIV weaning methods: gradual decrease in duration of NIV or level of ventilator support, and abrupt discontinuation of NIV.

Detailed Description

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Conditions

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Hypercapnic Respiratory Failure Weaning Failure Noninvasive Ventilation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Decrease in duration

Weaning will be started with the liberation of patient from NIV during day-time and then nighttime support will be gradually reduced. From day 2 the daytime NIV will be gradually decreased in steps of at least 2 hours/day at the attending discretion. At day 2, nighttime discontinuation will be considered. When a patient reaches without the presence of any reinstitution criteria, the duration of NIV use as 4 hours per 16 hours during daytime, it will be liberated definitively from NIV.

Group Type ACTIVE_COMPARATOR

Protocol for weaning of noninvasive ventilation

Intervention Type OTHER

3 protocols for weaning of noninvasive ventilation will be compared

Decrease in pressure and duration

Weaning will be started with the liberation of patient from NIV during day-time and then nighttime support will be gradually reduced. The level of pressure support will be decreased by 2-4 cmH2O per 4 hours during daytime in patients with good tolerance, with no change at night time. From day 2 the daytime NIV will be gradually decreased in steps of at least 2 hours/day at the attending discretion. At day 2, nighttime discontinuation will be considered, based on the vitals and ABGs recorded at 8 pm (see above), with gradual decrease of at least 2 hrs/night. When a patient reaches without the presence of any reinstitution criteria, the level of PS of 8 cmH20, it will be liberated definitively from NIV.

Group Type ACTIVE_COMPARATOR

Protocol for weaning of noninvasive ventilation

Intervention Type OTHER

3 protocols for weaning of noninvasive ventilation will be compared

Abrupt discontinuation of NIV

Patients will be disconnected from NIV and oxygenated with a nasal cannula. Oxygen flow will be limited to a maximum of 5L/min.

Group Type ACTIVE_COMPARATOR

Protocol for weaning of noninvasive ventilation

Intervention Type OTHER

3 protocols for weaning of noninvasive ventilation will be compared

Interventions

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Protocol for weaning of noninvasive ventilation

3 protocols for weaning of noninvasive ventilation will be compared

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Patients will be screened by the physician 24 hours (±6 hours) after initiation of NIV treatment if:

* Age ≥18 years old
* Hypercapnic ARF ( baseline pH\<7.35, paCO2\>45 mmHg, BORG\>4)
* Breathing frequency\< 25 bpm under NIV
* pH \>7.35 under NIV
* 10% or more decrease from baseline PaCO2 under NIV
* Kelly ≤ 2 under NIV (Alert. Follows simple/3 step complex commands)
* PaO2 between 60 and 70 mmHg under NIV
* No need for sedation
* Systolic blood pressure 90-180 mmHg without vasopressors
* Body temperature 36-38°C
* Heart rate 50-120 bpm

The patient will be enrolled to the study and will be randomized to one of the NIV weaning protocols, if passes daily weaning criteria listed below after 1 hour of spontaneous breathing (with supplementary oxygen),

* Respiratory rate 8-30 bpm
* Systolic blood pressure 90-180 mmHg without vasopressors
* Body temperature 36-38°C
* Heart rate 50-120 bpm
* Neurologic score of Kelly ≤2 (Alert. Follows simple/ 3-step complex commands),
* SaO2 ≥88-92% with a FiO2≤40%.
* pH≥7.35
* Absence of severe dyspnea (BORG\>4).

Exclusion Criteria

* Age \<18 years old
* NIV use at home for chronic respiratory failure
* CPAP use for acute respiratory failure
* NIV use as palliative treatment
* Severe heart failure with cardiac index ≤ 2 L/min/m2
* Severe hepatic failure with bilirubin ≥ 34.2µmol/L
* Severe renal failure with creatinine ≥ 220 µmol/L
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Bologna

OTHER

Sponsor Role collaborator

Marmara University

OTHER

Sponsor Role collaborator

Istanbul Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital

OTHER

Sponsor Role collaborator

Dokuz Eylul University

OTHER

Sponsor Role collaborator

Cukurova University

OTHER

Sponsor Role collaborator

Ospedale San Donato

OTHER

Sponsor Role collaborator

University of Milan

OTHER

Sponsor Role collaborator

Baskent University

OTHER

Sponsor Role lead

Responsible Party

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Aylin Ozsancak Ugurlu

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Stefano Nava

Role: STUDY_CHAIR

Bologna University

Begum Ergan

Role: STUDY_DIRECTOR

Dokuz Eylul University

Sait Karakurt

Role: PRINCIPAL_INVESTIGATOR

Marmara University

Ezgi Ozyılmaz

Role: PRINCIPAL_INVESTIGATOR

Cukurova University

Raffaele Scala

Role: PRINCIPAL_INVESTIGATOR

San Donato Hospital

Fabiano Di Marco

Role: PRINCIPAL_INVESTIGATOR

Milan University

Zuhal Karakurt

Role: PRINCIPAL_INVESTIGATOR

Sureyyapasa Center for Chest Diseases and Thoracic Surgery Training and Investiagation Hospital

Locations

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San Donato Hospital

Arezzo, , Italy

Site Status

Bologna University

Bologna, , Italy

Site Status

Milan University

Milan, , Italy

Site Status

Cukurova University

Adana, , Turkey (Türkiye)

Site Status

Sureyyapasa Center for Chest Diseases and Thoracic Surgery Training and Investiagation Hospital

Istanbul, , Turkey (Türkiye)

Site Status

Baskent University

Istanbul, , Turkey (Türkiye)

Site Status

Marmara University

Istanbul, , Turkey (Türkiye)

Site Status

Dokuz Eylul University

Izmir, , Turkey (Türkiye)

Site Status

Countries

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Italy Turkey (Türkiye)

Other Identifiers

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BaskentU

Identifier Type: -

Identifier Source: org_study_id

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