Trial Outcomes & Findings for Anesthetics to Prevent Lung Injury in Cardiac Surgery (NCT NCT02918877)

NCT ID: NCT02918877

Last Updated: 2021-05-05

Results Overview

Inflammatory mediator found in BAL fluid during lung inflammation

Recruitment status

COMPLETED

Study phase

PHASE1/PHASE2

Target enrollment

51 participants

Primary outcome timeframe

Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass

Results posted on

2021-05-05

Participant Flow

51 Enrolled

49 Randomized * Withdrew consent (1) * Surgery cancelled (1)

Participant milestones

Participant milestones
Measure
Inhaled Anesthesia
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
Overall Study
STARTED
24
25
Overall Study
COMPLETED
18
22
Overall Study
NOT COMPLETED
6
3

Reasons for withdrawal

Reasons for withdrawal
Measure
Inhaled Anesthesia
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
Overall Study
Withdrawal by Subject
2
2
Overall Study
Surgery cancelled
1
0
Overall Study
Physician Decision
1
0
Overall Study
Received intraoperative steroids
1
0
Overall Study
Unable to obtain lab samples
1
0
Overall Study
Unsafe to perform BAL
0
1

Baseline Characteristics

Anesthetics to Prevent Lung Injury in Cardiac Surgery

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Inhaled Anesthesia
n=18 Participants
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 Participants
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
Total
n=40 Participants
Total of all reporting groups
Comorbidities
Chronic Obstructive Pulmonary Disease/Asthma
2 Participants
n=5 Participants
2 Participants
n=7 Participants
4 Participants
n=5 Participants
Age, Continuous
61.3 Years
STANDARD_DEVIATION 10.1 • n=5 Participants
64.6 Years
STANDARD_DEVIATION 10.9 • n=7 Participants
62.9 Years
STANDARD_DEVIATION 10.5 • n=5 Participants
Sex: Female, Male
Female
2 Participants
n=5 Participants
5 Participants
n=7 Participants
7 Participants
n=5 Participants
Sex: Female, Male
Male
16 Participants
n=5 Participants
17 Participants
n=7 Participants
33 Participants
n=5 Participants
Race/Ethnicity, Customized
Race · White
16 Participants
n=5 Participants
15 Participants
n=7 Participants
31 Participants
n=5 Participants
Race/Ethnicity, Customized
Race · Black/African American
0 Participants
n=5 Participants
1 Participants
n=7 Participants
1 Participants
n=5 Participants
Race/Ethnicity, Customized
Race · Hispanic or Latino
2 Participants
n=5 Participants
3 Participants
n=7 Participants
5 Participants
n=5 Participants
Race/Ethnicity, Customized
Race · Unknown
0 Participants
n=5 Participants
3 Participants
n=7 Participants
3 Participants
n=5 Participants
Weight
207.82 Pounds
STANDARD_DEVIATION 39.60 • n=5 Participants
194.10 Pounds
STANDARD_DEVIATION 42.54 • n=7 Participants
200.96 Pounds
STANDARD_DEVIATION 41.07 • n=5 Participants
Height
69.11 Inches
STANDARD_DEVIATION 3.65 • n=5 Participants
68.41 Inches
STANDARD_DEVIATION 3.49 • n=7 Participants
68.76 Inches
STANDARD_DEVIATION 3.57 • n=5 Participants
Body Mass Index
31.20 kg/m^2
STANDARD_DEVIATION 4.34 • n=5 Participants
29.61 kg/m^2
STANDARD_DEVIATION 5.02 • n=7 Participants
30.41 kg/m^2
STANDARD_DEVIATION 4.68 • n=5 Participants
Comorbidities
Hypertension
15 Participants
n=5 Participants
18 Participants
n=7 Participants
33 Participants
n=5 Participants
Comorbidities
Hyperlipidemia
15 Participants
n=5 Participants
14 Participants
n=7 Participants
29 Participants
n=5 Participants
Comorbidities
Congestive Heart Failure
3 Participants
n=5 Participants
1 Participants
n=7 Participants
4 Participants
n=5 Participants
Comorbidities
Arrhythmia
1 Participants
n=5 Participants
3 Participants
n=7 Participants
4 Participants
n=5 Participants
Comorbidities
Obesity
6 Participants
n=5 Participants
3 Participants
n=7 Participants
9 Participants
n=5 Participants
Comorbidities
Diabetes without Complications
1 Participants
n=5 Participants
4 Participants
n=7 Participants
5 Participants
n=5 Participants
Comorbidities
Diabetes with End Organ Damage
3 Participants
n=5 Participants
5 Participants
n=7 Participants
8 Participants
n=5 Participants
Comorbidities
Moderate or Severe Renal Disease
3 Participants
n=5 Participants
0 Participants
n=7 Participants
3 Participants
n=5 Participants
Comorbidities
Solid (Non-Metastatic) Tumor
3 Participants
n=5 Participants
2 Participants
n=7 Participants
5 Participants
n=5 Participants
ASA Score (American Society of Anesthesiologists)
3.67 scores on a scale.
STANDARD_DEVIATION 0.48 • n=5 Participants
3.82 scores on a scale.
STANDARD_DEVIATION 0.39 • n=7 Participants
3.75 scores on a scale.
STANDARD_DEVIATION 0.44 • n=5 Participants
ARISCAT Score
50.28 scores on a scale
STANDARD_DEVIATION 10.20 • n=5 Participants
47.86 scores on a scale
STANDARD_DEVIATION 8.15 • n=7 Participants
49.07 scores on a scale
STANDARD_DEVIATION 9.18 • n=5 Participants

PRIMARY outcome

Timeframe: Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass

Inflammatory mediator found in BAL fluid during lung inflammation

Outcome measures

Outcome measures
Measure
Inhaled Anesthesia
n=18 Participants
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 Participants
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
Bronchoalveolar Lavage (BAL) Concentration of TNF Alpha (pg/mL)
Pre-Bypass
0.53 pg/mL
Interval 0.53 to 4.99
0.53 pg/mL
Interval 0.53 to 13.8
Bronchoalveolar Lavage (BAL) Concentration of TNF Alpha (pg/mL)
Post-Bypass
22.06 pg/mL
Interval 1.75 to 623.08
102.04 pg/mL
Interval 2.21 to 408.05
Bronchoalveolar Lavage (BAL) Concentration of TNF Alpha (pg/mL)
Difference
17.24 pg/mL
Interval 1.22 to 536.77
101.51 pg/mL
Interval 1.47 to 402.84

SECONDARY outcome

Timeframe: Assessed daily, beginning on the first day after surgery, until hospital discharge or death. On average at our institution, most patients are discharged within 7 days so this is the expected time frame for follow up.

Composite endpoint of clinically relevant pulmonary complications

Outcome measures

Outcome measures
Measure
Inhaled Anesthesia
n=18 Participants
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 Participants
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
Number of Patients With Postoperative Pulmonary Complications
Prolonged intubation (greater than 48hrs)
0 Participants
3 Participants
Number of Patients With Postoperative Pulmonary Complications
Failed extubation (re-intubated within 24hrs)
0 Participants
1 Participants
Number of Patients With Postoperative Pulmonary Complications
Reintubation (greater than 24hrs after extubation)
0 Participants
2 Participants
Number of Patients With Postoperative Pulmonary Complications
Pulmonary edema
4 Participants
8 Participants
Number of Patients With Postoperative Pulmonary Complications
Pleural effusion
17 Participants
21 Participants
Number of Patients With Postoperative Pulmonary Complications
Atelectasis
16 Participants
19 Participants
Number of Patients With Postoperative Pulmonary Complications
Infiltrate/consolidation
6 Participants
6 Participants
Number of Patients With Postoperative Pulmonary Complications
Pneumothorax
1 Participants
5 Participants
Number of Patients With Postoperative Pulmonary Complications
ARDS
0 Participants
0 Participants
Number of Patients With Postoperative Pulmonary Complications
Pneumonia
0 Participants
1 Participants
Number of Patients With Postoperative Pulmonary Complications
Brochospasm
1 Participants
1 Participants
Number of Patients With Postoperative Pulmonary Complications
Exacerbation of chronic lung disease
0 Participants
0 Participants
Number of Patients With Postoperative Pulmonary Complications
Hypoxia (PaO2/FiO2 < 300)
16 Participants
15 Participants
Number of Patients With Postoperative Pulmonary Complications
Respiratory acidosis (PaCO2 > 45)
12 Participants
15 Participants
Number of Patients With Postoperative Pulmonary Complications
Any postoperative pulmonary complication
18 Participants
22 Participants

SECONDARY outcome

Timeframe: Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass

Inflammatory mediator found in BAL fluid during lung inflammation

Outcome measures

Outcome measures
Measure
Inhaled Anesthesia
n=18 Participants
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 Participants
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
BAL Concentration of IL1b (pg/mL)
Pre-Bypass
0.42 pg/mL
Interval 0.06 to 2.61
0.87 pg/mL
Interval 0.28 to 2.54
BAL Concentration of IL1b (pg/mL)
Post-Bypass
8.56 pg/mL
Interval 0.21 to 64.77
14.37 pg/mL
Interval 1.88 to 76.1
BAL Concentration of IL1b (pg/mL)
Difference
8.30 pg/mL
Interval -0.67 to 59.64
11.00 pg/mL
Interval 1.18 to 66.14

SECONDARY outcome

Timeframe: Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass

Inflammatory mediator found in BAL fluid during lung inflammation

Outcome measures

Outcome measures
Measure
Inhaled Anesthesia
n=18 Participants
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 Participants
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
BAL Concentration of IL6 (pg/mL)
Pre-Bypass
30.70 pg/mL
Interval 6.77 to 96.6
31.35 pg/mL
Interval 5.27 to 165.93
BAL Concentration of IL6 (pg/mL)
Post-Bypass
275.19 pg/mL
Interval 6.21 to 1134.33
297.35 pg/mL
Interval 40.59 to 1277.04
BAL Concentration of IL6 (pg/mL)
Difference
220.68 pg/mL
Interval -12.41 to 1046.0
259.32 pg/mL
Interval 30.33 to 1039.58

SECONDARY outcome

Timeframe: Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass

Inflammatory mediator found in BAL fluid during lung inflammation

Outcome measures

Outcome measures
Measure
Inhaled Anesthesia
n=18 Participants
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 Participants
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
BAL Concentration of IL8 (pg/mL)
Pre-Bypass
2008.50 pg/mL
Interval 341.25 to 16444.75
6528.50 pg/mL
Interval 625.0 to 16332.25
BAL Concentration of IL8 (pg/mL)
Post-Bypass
8019.50 pg/mL
Interval 998.25 to 100438.0
27789.50 pg/mL
Interval 4780.5 to 154087.75
BAL Concentration of IL8 (pg/mL)
Difference
4701.00 pg/mL
Interval -290.25 to 77061.0
16230.00 pg/mL
Interval 1399.25 to 123098.5

SECONDARY outcome

Timeframe: Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass

Inflammatory mediator found in BAL fluid during lung inflammation

Outcome measures

Outcome measures
Measure
Inhaled Anesthesia
n=18 Participants
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 Participants
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
BAL Concentration of MCP1 (pg/mL)
Pre-Bypass
509.50 pg/mL
Interval 249.25 to 1415.75
977.50 pg/mL
Interval 336.5 to 1225.75
BAL Concentration of MCP1 (pg/mL)
Post-Bypass
496.00 pg/mL
Interval 184.25 to 2153.25
883.50 pg/mL
Interval 651.5 to 4380.5
BAL Concentration of MCP1 (pg/mL)
Difference
148.00 pg/mL
Interval -265.75 to 869.75
479.50 pg/mL
Interval -104.25 to 1482.75

SECONDARY outcome

Timeframe: Change from baseline and 2-4 hours after exposure to cardiopulmonary bypass

Biomarker of lung injury (RAGE - receptor for advance glycosylation end products)

Outcome measures

Outcome measures
Measure
Inhaled Anesthesia
n=18 Participants
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 Participants
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
BAL Concentration of sRAGE (pg/mL)
Pre-Bypass
156.50 pg/mL
Interval 44.0 to 383.0
164 pg/mL
Interval 60.75 to 380.5
BAL Concentration of sRAGE (pg/mL)
Post-Bypass
597.00 pg/mL
Interval 220.5 to 1195.0
465.00 pg/mL
Interval 206.0 to 2120.5
BAL Concentration of sRAGE (pg/mL)
Difference
402.50 pg/mL
Interval 155.25 to 1063.25
224.50 pg/mL
Interval -69.25 to 2088.25

Adverse Events

Inhaled Anesthesia

Serious events: 0 serious events
Other events: 18 other events
Deaths: 0 deaths

Intravenous Anesthesia

Serious events: 0 serious events
Other events: 22 other events
Deaths: 1 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Inhaled Anesthesia
n=18 participants at risk
Patients in the inhaled anesthesia arm will be given sevoflurane anesthesia maintenance for the duration of the procedure including cardiopulmonary bypass. Sevoflurane: Volatile Anesthetic
Intravenous Anesthesia
n=22 participants at risk
Patients in the intravenous anesthesia arm will be given total intravenous anesthesia with propofol for the duration of the procedure including cardiopulmonary bypass. Propofol: Intravenous Anesthetic
Respiratory, thoracic and mediastinal disorders
Prolonged intubation (greater than 48hrs)
0.00%
0/18 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
13.6%
3/22 • Number of events 3 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Failed extubation (re-intubated within 24hrs)
0.00%
0/18 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
4.5%
1/22 • Number of events 1 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Reintubation (greater than 24hrs after extubation)
0.00%
0/18 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
9.1%
2/22 • Number of events 2 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Pulmonary edema
22.2%
4/18 • Number of events 4 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
36.4%
8/22 • Number of events 8 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Pleural effusion
94.4%
17/18 • Number of events 17 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
95.5%
21/22 • Number of events 21 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Atelectasis
88.9%
16/18 • Number of events 16 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
86.4%
19/22 • Number of events 19 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Infiltrate/consolidation
33.3%
6/18 • Number of events 6 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
27.3%
6/22 • Number of events 6 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Pneumothorax
5.6%
1/18 • Number of events 1 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
22.7%
5/22 • Number of events 5 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Pneumonia
0.00%
0/18 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
4.5%
1/22 • Number of events 1 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Brochospasm
5.6%
1/18 • Number of events 1 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
4.5%
1/22 • Number of events 1 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Hypoxia (PaO2/FiO2 < 300)
88.9%
16/18 • Number of events 16 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
68.2%
15/22 • Number of events 15 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
Respiratory, thoracic and mediastinal disorders
Respiratory acidosis (PaCO2 > 45)
66.7%
12/18 • Number of events 12 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.
68.2%
15/22 • Number of events 15 • During hospital length of stay ~7 days
During this study, the research team did not record every adverse event. As shown in the table below (as well as the Outcome Measure 2 data), only study related events were recorded.

Additional Information

Dr. Brian P. O'Gara

Beth Israel Deaconess Medical Center

Phone: 617-549-2974

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place