Practice of Ventilation in Middle-Income Countries

NCT ID: NCT03188770

Last Updated: 2019-07-05

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Total Enrollment

1315 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-11-01

Study Completion Date

2019-01-29

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The purpose of this international, multicenter service review is to describe and compare ventilation management in patients at risk of acute respiratory distress syndrome (ARDS) versus patients not at risk and patients with established ARDS, and to ascertain whether certain ventilator settings and ventilation parameters are associated with pulmonary complications or development of ARDS after start of ventilation in patients in intensive care units (ICUs) in Asian countries.

Participating centers will include adult patients undergoing mechanical ventilation in the ICU during a 28-day period. Patients' data will be collected during the first 7 days in the ICU, or until ICU discharge. Follow up is until ICU discharge. The primary outcome includes two main ventilator settings, i.e., tidal volume and the level of positive end-expiratory pressure. Secondary endpoints are development of ARDS in patients without ARDS at the onset of mechanical ventilation, worsening of ARDS in patients with ARDS at the onset of mechanical ventilation, pulmonary infection, other pulmonary complications, need for tracheostomy, duration of ventilation, length of ICU stay and ICU mortality.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Rationale: scarce information exists on management of mechanical ventilation in intensive care unit (ICU) patients in low- and middle-income countries.

Objective:The primary objective is to describe and compare ventilation management in patients at risk of ARDS versus individuals not at risk, and patients with established ARDS, and to ascertain whether certain ventilation settings are associated with a higher incidence of developing ARDS in patients in ICUs in Asia. PRoVENT-iMIC secondary objectives are to determine the epidemiological characteristics and clinical outcomes of patients at risk of ARDS in ICUs in Asia according to the ventilation practice applied.

Primary hypothesis: a large proportion of patients at risk of ARDS in ICUs in Asia do not receive so-called protective ventilation, defined as tidal volume \< 8 ml/kg predicted body weight and a level of positive end-expiratory pressure of at least 5 cm H2O.

Secondary hypothesis: in ICUs in Asia a large proportion of patients is at risk of ARDS, as stratified by a Lung Injury Prediction Score of ≥4.

Study design: an international multicenter service review focusing on ICUs in selected middle-income Asian countries.

Population: consecutive intubated and ventilated ICU patients.

Methods: Patients in participating ICUs will be screened daily during a 28-day period. A registry of limited demographic data will be compiled on all screened patients. Collection of ventilation characteristics is restricted to the first three days. The first seven days or up to death, whichever comes first, will be used for collection of patient demographics (on day of admission), development of ARDS and other pulmonary complications. All patients will be followed until ICU-discharge to determine length of stay in ICU and ICU mortality. The inclusion period will be flexible for participating centers and determined at a later stage together with the study-coordinator. Data will be coded by a patient identification number of which the code will be kept safe at the local sites. The data will be transcribed by local investigators onto an internet based electronic case report form (https://www.project-redcap.org).

Centers: about 60 Asian ICUs from ten countries are expected to participate in this international multicenter study. Each participating center will recruit \~ 50 patients.

Ethics Approval: The Oxford Tropical Research Ethical Committee has evaluated the study and considered it exempt from ethical review on the 1st of June 2017. National coordinators will be responsible for clarifying the need for ethics approval and applying for this where appropriate according to local policy. Centers will not be permitted to record data unless ethics approval or an equivalent waiver is in place.

Monitoring: Due to the observational nature of the study, a Data Safety and Monitoring Board is not necessary.

Sample Size Calculation: a formal sample size calculation was not performed, seen the largely descriptive character of this investigation. 3000 patients are expected to be enrolled in the study period, which will be sufficient to test the hypotheses.

Statistical Analysis: Patient characteristics will be compared and described by appropriate statistics. Student's t-test or Mann-Whitney U-tests are used to compare continuous variables and chi-squared tests are used for categorical variables. Data are expressed as means (SD), medians (interquartile range) and proportions as appropriate. Comparisons between and within groups are performed using one-way ANOVA and post-hoc analyses for continuous variables.

The primary analysis concerns the determination of (variation of) tidal volume and PEEP levels in patients without ARDS. These are compared between predefined patient groups: patients at no risk for ARDS, patients at risk for ARDS, patients with mild ARDS, and patients with moderate or severe ARDS.

To identify potential factors associated with outcome like development of ARDS, or worsening of ARDS, development of pulmonary complications, duration of ventilation, or death, univariate analyses are performed. A multivariate logistic regression model is used to identify independent risk factors. A stepwise approach is used to enter new terms into the model, with a limit of p \< 0.2 to enter the terms. Time to event variables are analyzed using Cox regression and visualized by Kaplan-Meier.

Organization: The study is conducted by the PROtective VEntilation Network (PROVENet). National co-ordinators will lead the project within individual nations and identify participating hospitals, translate study paperwork, distribute study paperwork and ensure necessary regulatory approvals are in place. They provide assistance to the participating clinical sites in trial management, record keeping and data management. Local coordinators in each site will supervise data collection and ensure adherence to Good Clinical Practice during the trial.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Mechanical Ventilation Respiratory Distress Syndrome, Adult Acute Respiratory Failure

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Mechanical Ventilation

Patients under mechanical ventilation in the ICU

No interventions assigned to this group

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Admitted to an ICU participating in this study
* Intubated in the ICU, or in the emergency room, general ward, or operation room before the present ICU admission

Exclusion Criteria

* Age \< 18 years
* Patients under invasive mechanical ventilation previous to the 28-day period of inclusion
* Patients transferred from another hospital under invasive mechanical ventilation
* Receiving only non-invasive ventilation (i.e., patient never received invasive ventilation during the present admission)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Mahidol Oxford Tropical Medicine Research Unit

OTHER

Sponsor Role collaborator

Hospital Israelita Albert Einstein

OTHER

Sponsor Role collaborator

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Prof. Dr. Marcus J. Schultz

Prof.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Marcus J Schultz, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Intensive Care, Academic Medical Center, University of Amsterdam

Arjen M Dondorp, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Mahidol Oxford Research Unit, University of Oxford

Luigi Pisani, MD

Role: STUDY_DIRECTOR

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

Ary Serpa Neto, MD, MSc

Role: STUDY_CHAIR

Hospital Israelita Albert Einstein

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Chittagong Medical College Hospital

Chittagong, , Bangladesh

Site Status

Bangabandhu Sheikh Mujib Medical University

Dhaka, , Bangladesh

Site Status

BIRDEM General Hospital

Dhaka, , Bangladesh

Site Status

Dhaka Medical College Hospital

Dhaka, , Bangladesh

Site Status

Rajshahi Medical College Hospital

Rajshahi, , Bangladesh

Site Status

Sylhet MAG Osmani Medical College Hospital

Sylhet, , Bangladesh

Site Status

Ispat General Hospital

Raurkela, Odisha, India

Site Status

St. John's Medical College

Bangalore, , India

Site Status

Bharati Vidyapeeth Medical College

Pune, , India

Site Status

Modarres Hospital

Tehran, , Iran

Site Status

Pars Hospital

Tehran, , Iran

Site Status

Masih Daneshvari Hospital

Tehrān, , Iran

Site Status

Monash University

Johor Bahru, , Malaysia

Site Status

Hospital Kuala Lumpur

Kuala Lumpur, , Malaysia

Site Status

Mohamad Irfan Bin Othman Jailani

Kuala Lumpur, , Malaysia

Site Status

International Islamic University Medical Center

Kuantan, , Malaysia

Site Status

Indira Gandhi Memorial Hospital

Malè, , Maldives

Site Status

Patan Academy of Health Sciences

Kathmandu, , Nepal

Site Status

Allied Hospital

Faisalābad, , Pakistan

Site Status

PIMS

Islamabad, , Pakistan

Site Status

Shifa International Hospital

Islamabad, , Pakistan

Site Status

Aga Khan University Hospital MICU

Karachi, , Pakistan

Site Status

Aga Khan University SICU

Karachi, , Pakistan

Site Status

Patel Hospital

Karachi, , Pakistan

Site Status

Doctor's Hospital

Lahore, , Pakistan

Site Status

National Hospital and Medical Center

Lahore, , Pakistan

Site Status

Peoples Medical College Hospital

Nawabshah, , Pakistan

Site Status

North West General Hospital

Peshawar, , Pakistan

Site Status

Batticaloa Base Hospital

Batticaloa, , Sri Lanka

Site Status

Colombo South Teaching Hospital MICU

Colombo, , Sri Lanka

Site Status

Colombo South Teaching Hospital SICU

Colombo, , Sri Lanka

Site Status

Lanka Hospital

Colombo, , Sri Lanka

Site Status

National Hospital Sri Lanka MICU

Colombo, , Sri Lanka

Site Status

National Hospital Sri Lanka SICU

Colombo, , Sri Lanka

Site Status

Sri Jayawardenepura CTICU

Colombo, , Sri Lanka

Site Status

Sri Jayewardenepura General Hospital GICU

Colombo, , Sri Lanka

Site Status

Karapitiya Teaching Hospital

Galle, , Sri Lanka

Site Status

Jaffna Teaching Hospital

Jaffna, , Sri Lanka

Site Status

Puttlam Hospital

Puttalam, , Sri Lanka

Site Status

Chulalongkorn University Hospital

Bangkok, , Thailand

Site Status

Hospital for Tropical Diseases, Mahidol University

Bangkok, , Thailand

Site Status

Ramathibodi Hospital

Bangkok, , Thailand

Site Status

Sriraj Hospital

Bangkok, , Thailand

Site Status

Vajira Hospital

Bangkok, , Thailand

Site Status

Chiang Mai Hospital Surgical ICU

Chiang Mai, , Thailand

Site Status

Chiang Mai Medical ICU

Chiang Mai, , Thailand

Site Status

Nakornping Hospital

Chiang Mai, , Thailand

Site Status

Prince of Songkla University

Hat Yai, , Thailand

Site Status

Srinakharinwirot University

Ongkharak, , Thailand

Site Status

National Hospital for Tropical Diseases

Hanoi, , Vietnam

Site Status

Oxford University Clinical Research Unit

Ho Chi Minh City, , Vietnam

Site Status

Countries

Review the countries where the study has at least one active or historical site.

Bangladesh India Iran Malaysia Maldives Nepal Pakistan Sri Lanka Thailand Vietnam

References

Explore related publications, articles, or registry entries linked to this study.

Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, Pasqualucci Mde O, Damasceno MC, Schultz MJ. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012 Oct 24;308(16):1651-9. doi: 10.1001/jama.2012.13730.

Reference Type BACKGROUND
PMID: 23093163 (View on PubMed)

Neto AS, Barbas CSV, Simonis FD, Artigas-Raventos A, Canet J, Determann RM, Anstey J, Hedenstierna G, Hemmes SNT, Hermans G, Hiesmayr M, Hollmann MW, Jaber S, Martin-Loeches I, Mills GH, Pearse RM, Putensen C, Schmid W, Severgnini P, Smith R, Treschan TA, Tschernko EM, Melo MFV, Wrigge H, de Abreu MG, Pelosi P, Schultz MJ; PRoVENT; PROVE Network investigators. Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study. Lancet Respir Med. 2016 Nov;4(11):882-893. doi: 10.1016/S2213-2600(16)30305-8. Epub 2016 Oct 4.

Reference Type RESULT
PMID: 27717861 (View on PubMed)

Serafini SC, Cinotti R, Asehnoune K, Battaglini D, Robba C, Neto AS, Pisani L, Mazzinari G, Tschernko EM, Schultz MJ; PRoVENT, the PRoVENT-iMiC and ENIO, investigators. Potentially modifiable ventilation factors associated with outcome in neurocritical care vs. non-neurocritical care patients: Rational and protocol for a patient-level analysis of PRoVENT, PRoVENT-iMiC and ENIO (PRIME). Rev Esp Anestesiol Reanim (Engl Ed). 2025 May;72(5):501690. doi: 10.1016/j.redare.2025.501690. Epub 2025 Feb 15.

Reference Type DERIVED
PMID: 39961531 (View on PubMed)

Serafini SC, van Meenen DMP, Pisani L, Neto AS, Ball L, de Abreu MG, Algera AG, Azevedo L, Bellani G, Dondorp AM, Fan E, Laffey JG, Pham T, Tschernko EM, Schultz MJ, van der Woude MCE; ERICC; LUNG SAFE; PRoVENT; PRoVENT-iMiC-investigators. Different ventilation intensities among various categories of patients ventilated for reasons other than ARDS--A pooled analysis of 4 observational studies. J Crit Care. 2024 Jun;81:154531. doi: 10.1016/j.jcrc.2024.154531. Epub 2024 Feb 10.

Reference Type DERIVED
PMID: 38341938 (View on PubMed)

Pisani L, Algera AG, Serpa Neto A, Ahsan A, Beane A, Chittawatanarat K, Faiz A, Haniffa R, Hashemian R, Hashmi M, Imad HA, Indraratna K, Iyer S, Kayastha G, Krishna B, Moosa H, Nadjm B, Pattnaik R, Sampath S, Thwaites L, Tun NN, Yunos NM, Grasso S, Paulus F, de Abreu MG, Pelosi P, Dondorp AM, Schultz MJ; PRoVENT-iMIC investigators, MORU and the PROVE network. PRactice of VENTilation in Middle-Income Countries (PRoVENT-iMIC): rationale and protocol for a prospective international multicentre observational study in intensive care units in Asia. BMJ Open. 2018 Apr 28;8(4):e020841. doi: 10.1136/bmjopen-2017-020841.

Reference Type DERIVED
PMID: 29705765 (View on PubMed)

Provided Documents

Download supplemental materials such as informed consent forms, study protocols, or participant manuals.

Document Type: Statistical Analysis Plan

View Document

Related Links

Access external resources that provide additional context or updates about the study.

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

PRoVENT-iMIC

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.