Effect of Parallel Oxygen Delivery Through a Tracheal Gas Insufflation (TGI) and a T-piece, on Blood Gases and Respiratory Rate, in ICU Tracheostomized Patients

NCT ID: NCT03040297

Last Updated: 2018-01-10

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

11 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-11-30

Study Completion Date

2017-05-31

Brief Summary

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The study investigates if there are benefits (better oxygenation, minimized work of breath) from the parallel oxygenation with Tracheal Gas Insufflation and T-piece, in order to provide respiratory support in tracheostomized patients and avoid mechanical ventilation.

Detailed Description

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The tracheal insufflation (TGI) of respiratory gasses near to carina is a technique who designed for the removement of exhaled carbon dioxide from the dead space of the lung. In order to investigate the utility of this technique on weaning of mechanical ventilation 11 tracheostomized patients on T-piece were recruited, with stable blood gasses more than 24 hours.

A TGI catheter enters the trachea through a new opened hole on the top of T-piece and then passes through the tracheostomy tube to inside of the trachea and then stops one centimeter before the carina. Patients received two parallel administered respiratory gases with the same fraction of inspired oxygen (FiO2), through a T-piece and an endotracheal catheter, with flows 6 Liters Per Minute (L/min) and 11 L/min, while continuously monitored by impedance tomography device (ΕΙΤ). ΕΙΤ is a noninvasive imaging technique for monitoring in real time the lung volumes and the regional lung ventilation without ionizing radiation.

The basic hypothesis of the study is if there are benefits (better oxygenation, minimized work of breath) from the parallel oxygenation with Tracheal Gas Insufflation and T-piece, in order to provide respiratory support in tracheostomized patients and avoid mechanical ventilation.

The randomization of the study was achieved using sealed envelopes method and associated with the flow to be first (6L/min or 11L/min) via Tracheal Gas Insufflation Catheter (6 envelopes with the inscription 6 L/min on the inner side and 6 envelopes with the inscription 6 L/min on the inner side 11 L/min)

Τhe investigators tested the differences on partial pressure of oxygen (PaO2), respiratory rate and end expiratory impedance:

1. Before gasses supply via TGI
2. During 6L/min
3. During 11L/min
4. And finally with no gasses supply via TGI

Additionally the following were monitored:

* Heart rate
* Systolic and diastolic blood pressure
* Oxygen saturation as disturbing factors and,
* potential of hydrogen (pH)
* PaCO2
* hydrogen carbonate (-HCO3) for the monitoring of the acid-base balance of the patient during procedure.

Conditions

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Resp Gas Exchange Disorder Nos

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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TGI 6 L/min

Tracheal gas insufflation 6 L/min

Group Type ACTIVE_COMPARATOR

Tracheal gas insufflation 6 L/min

Intervention Type DEVICE

Endotracheal flow (6 L/min) of respiratory gases with standard FiO2

TGI 11 L/min

Tracheal gas insufflation 11 L/min

Group Type ACTIVE_COMPARATOR

Tracheal gas insufflation 11 L/min

Intervention Type DEVICE

Endotracheal flow (11 L/min) of respiratory gases with standard FiO2

TGI 0 L/min

Tracheal gas insufflation catheter, without gas flow

Group Type ACTIVE_COMPARATOR

Tracheal gas insufflation catheter, without gas flow

Intervention Type DEVICE

Tracheal gas insufflation catheter, without gas flow

Interventions

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Tracheal gas insufflation 6 L/min

Endotracheal flow (6 L/min) of respiratory gases with standard FiO2

Intervention Type DEVICE

Tracheal gas insufflation 11 L/min

Endotracheal flow (11 L/min) of respiratory gases with standard FiO2

Intervention Type DEVICE

Tracheal gas insufflation catheter, without gas flow

Tracheal gas insufflation catheter, without gas flow

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Tracheostomized haemodynamically stable patients, without the need of vasopressors or inotrope medications, without symptoms of pulmonary edema, or interstitial lung diseases.

Stable blood gasses (no bigger changes than 15-20% in Oxygen and Carbon dioxide during last 24 hours)

Exclusion Criteria

* Peripheral body temperature \< 38 C, White blood cells (WBCs) \< 15 x 109/L
* Respiratory rate \>35
* Paradoxical breathing
* Abdominal muscle recruitment
* Dyspnoea, SaO2 \< 94, without evidence of angina, cyanosis or arrhythmia.
* Chest circumferences no bigger than 110 cm (for the larger belt of impedance tomograph)
Minimum Eligible Age

18 Years

Maximum Eligible Age

86 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National and Kapodistrian University of Athens

OTHER

Sponsor Role collaborator

Attikon Hospital

OTHER

Sponsor Role lead

Responsible Party

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Konstantinos Grigoriadis

Physical Therapist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Konstantinos E Grigoriadis, Pt, MSc

Role: PRINCIPAL_INVESTIGATOR

National and Kapodistrian University of Athens

Iraklis Tsagaris, MD. PhD

Role: STUDY_CHAIR

National and Kapodistrian University of Athens

Antonia D Koutsoukou, MD, PhD

Role: STUDY_CHAIR

National and Kapodistrian University of Athens

Eirini P Grammatopoulou, PT, PhD

Role: STUDY_CHAIR

Technological Educational Institution of Athens

Anna K Grigoriadou, PT

Role: STUDY_CHAIR

Lamia University of Applied Sciences

Apostolos E Armaganidis

Role: STUDY_DIRECTOR

National and Kapodistrian University of Athens

Locations

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Attikon University Hospital

Athens, Attica, Greece

Site Status

Countries

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Greece

References

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Knebel AR. When weaning from mechanical ventilation fails. Am J Crit Care. 1992 Nov;1(3):19-29; quiz 30-1.

Reference Type BACKGROUND
PMID: 1307903 (View on PubMed)

Durbin CG Jr. Tracheostomy: why, when, and how? Respir Care. 2010 Aug;55(8):1056-68.

Reference Type BACKGROUND
PMID: 20667153 (View on PubMed)

Blanch LL. Clinical studies of tracheal gas insufflation. Respir Care. 2001 Feb;46(2):158-66.

Reference Type BACKGROUND
PMID: 11175244 (View on PubMed)

Hoffman LA, Tasota FJ, Delgado E, Zullo TG, Pinsky MR. Effect of tracheal gas insufflation during weaning from prolonged mechanical ventilation: a preliminary study. Am J Crit Care. 2003 Jan;12(1):31-9.

Reference Type BACKGROUND
PMID: 12526235 (View on PubMed)

Hess DR, Gillette MA. Tracheal gas insufflation and related techniques to introduce gas flow into the trachea. Respir Care. 2001 Feb;46(2):119-29.

Reference Type BACKGROUND
PMID: 11175241 (View on PubMed)

Nahum A. Animal and lung model studies of tracheal gas insufflation. Respir Care. 2001 Feb;46(2):149-57.

Reference Type BACKGROUND
PMID: 11175243 (View on PubMed)

Kacmarek RM. Complications of tracheal gas insufflation. Respir Care. 2001 Feb;46(2):167-76.

Reference Type BACKGROUND
PMID: 11175245 (View on PubMed)

Other Identifiers

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13.4.4.25/05/16

Identifier Type: -

Identifier Source: org_study_id

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