Non-invasive Ventilation Versus High Flow Oxygen

NCT ID: NCT03758508

Last Updated: 2023-03-22

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

RECRUITING

Clinical Phase

NA

Total Enrollment

128 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-01

Study Completion Date

2025-12-01

Brief Summary

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The purpose of the study is to compare the efficacy of alternating Non Invasive Ventilation NIV and High Flow Oxygen HFO compared to High Flow Oxygen HFO alone on gas exchanges and prognosis in pneumonia-associated acute hypoxemic respiratory failure

Detailed Description

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Both Non Invasive Ventilation (NIV) and High Flow Oxygen through nasal cannula (HFO) are widely used in the setting of hypoxemic respiratory failure of heterogeneous etiology, with no definitive evidence for the superiority of one technique on the other. The purpose of this study is to determine whether alternating NIV and HFO brings any advantage on gas exchanges and prognosis compared to the use of HFO alone in the homogeneous setting of pneumonia-associated acute hypoxemic respiratory failure

Conditions

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Pneumonia-associated Acute Hypoxemic Respiratory Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Efficacy of alternating NIV and HFO compared to HFO alone in the determination of an improvement of PaO2/FiO2 at 21 hours compared to baseline PaO2/FiO2
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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HFO

Continuous high flow oxygen through nasal cannula for 45 hours; longer if the clinical need persists

Group Type ACTIVE_COMPARATOR

High Flow Oxygen nasal cannula

Intervention Type DEVICE

High Flow Oxygen nasal cannula

NIV/HFO

Alternating noninvasive ventilation (3 hours) and high flow oxygen through nasal cannula (3 hours) for 45 hours; longer if the clinical need persists

Group Type ACTIVE_COMPARATOR

High Flow Oxygen nasal cannula

Intervention Type DEVICE

High Flow Oxygen nasal cannula

Noninvasive ventilation

Intervention Type DEVICE

In this arm, participants receive noninvasive ventilation through an interface (such as full face mask or oro-nasal mask) alternated with continuous high flow oxygen though humidified nasal cannula

Interventions

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High Flow Oxygen nasal cannula

High Flow Oxygen nasal cannula

Intervention Type DEVICE

Noninvasive ventilation

In this arm, participants receive noninvasive ventilation through an interface (such as full face mask or oro-nasal mask) alternated with continuous high flow oxygen though humidified nasal cannula

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of pneumonia based on at least two clinical/laboratory criteria and 1 radiologic criterion among the following:

* Clinical criteria: fever, cough, purulent sputum, pulmonary examination positive for signs consistent with pneumonia
* Laboratory criteria: leukocytosis (White blood cells \>10000/mcL) or leukopenia (White blood cells \< 4000/mcL), rise of the inflammatory markers
* Radiologic criteria: consolidations at Chest X-ray or CT scan
* Hypoxemic respiratory failure, based on all the following criteria

* PaO2/FiO2 \< 300 after at least 15 minutes conventional oxygen therapy with a FiO2 ≥ 50%
* Respiratory Rate (RR) ≥ 25/min or need for use of accessory muscles
* Informed consent to study participation

Exclusion Criteria

* Age \< 18 years
* Hypercapnic respiratory failure (pCO2 \> 60 mmHg at presentation) such as in Chronic Obstructive Pulmonary Disease
* Presence of another cause of hypoxemic respiratory failure - e.g. pulmonary embolism, acute respiratory distress syndrome (ARDS), pulmonary oedema
* Hemodynamic instability with necessity for use of inotropes and/or vasopressors
* Indication for endotracheal intubation (ETI): Glasgow Coma Scale (GCS) \<8, agitation, device intolerance, respiratory arrest
* Immunosuppression (chronic immunosuppressive therapy, clinical history positive for any immunodeficiency - congenital or acquired)
* Do Not Resuscitate (DNR) and Do Not Intubate (DNI) indication
* Tracheostomy
* Nocturnal CPAP ventilation therapy
* Any other condition which the clinician would considered an adjunctive risk for taking part in the study or that would not permit the participant to complete it
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Niguarda Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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ASST Grande Ospedale Metropolitano Niguarda

Milan, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Andrea Bellone, MD

Role: CONTACT

00396444 ext. 2495

Facility Contacts

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Andrea Bellone, MD

Role: primary

0039026444 ext. 7438

Other Identifiers

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03-022018

Identifier Type: -

Identifier Source: org_study_id

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