Efficacy of Volume Ventilation in Patients With Acute Respiratory Failure at Risk of Obstructive Apneas or Obesity Hypoventilation

NCT ID: NCT04131660

Last Updated: 2026-01-22

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

COMPLETED

Clinical Phase

NA

Total Enrollment

14 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-12-04

Study Completion Date

2021-06-30

Brief Summary

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This study compares a volume targeted pressure support non-invasive ventilation with an automatic PEP regulation (AVAPS-AE mode) to a pressure support non-invasive ventilation (S/T mode) in patients with acute hypercapnic respiratory failure with acidosis. This study focuses on patients at risk of obstructive apneas or obesity-hypoventilation syndrom (BMI≥30 kg/m²). Half of participants (33 patients) will receive non invasive ventilation with AVAPS-AE mode, the other half will receive non-invasive ventilation with S/T mode.

Detailed Description

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So far, in respiratory intensive care units, the usual treatment of patients with acute hypercapnic respiratory failure with acidosis is non-invasive ventilation set with a pressure support mode (S/T or VS/AI mode depending on the ventilator manufacturer).

AVAPS-AE mode is a volume targeted pressure support mode with an automatic PEP. With the forced oscillations method, the ventilator is able to detect the obstruction and the resistances of upper airways.

It allows the ventilator to change its pressure settings to keep the targeted volume and avoid apneas and hypoventilation.

That is why in patients with a BMI \> 30 kg/m², at risk of obesity hypoventilation syndrom or obstructive apneas, this ventilation mode may be interesting.

AVAPS-AE has been evaluated in the home ventilation showing it is as efficient as S/T mode in controlling PaCO2.

However it has never been compared to S/T mode in acute respiratory failure care.

Conditions

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Acute Respiratory Failure Hypercapnic Respiratory Failure Respiratory Acidosis Obesity Hypoventilation Syndrome Apnea, Obstructive

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The patients are randomized in 2 arms at their admission :

* S/T mode arm : the patient is ventilated as the standard procedure of the ICU, with settings defined by the pratician.
* AVAPS-AE mode arm : the pratician sets NIV with a positive expiratory pressure set between 4 and 14 cmH2O, an inspiratory support between 14 and 24 cmH2O and a target tidal volume between 8 and 10 mL/kg of an ideal weight (Size (m) \* Size (m) \* 23).
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
The ventilator used in both arms will be similar in appareance.

Study Groups

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AVAPS-AE mode

A volume targeted pressure support ventilation mode

Group Type EXPERIMENTAL

AVAPS-AE mode during NIV

Intervention Type DEVICE

NIV will be setup in AVAPS-AE mode, with a Trilogy ventilation device (Respironics, Murrysville, PA). The range of positive expiratory pressure will be set between 4 and 14 cmH2O. The range of inspiratory pressure support will be set between 14 and 24 cmH2. The target tidal volume will be set to achieve 8 to 10 mL/kg of ideal body weight (Size (m) \* Size (m) \* 23).

S/T mode

A pressure support ventilation mode

Group Type ACTIVE_COMPARATOR

S/T mode during NIV

Intervention Type DEVICE

NIV will be setup in ST mode, with a Trilogy ventilation device (Respironics, Murrysville, PA).

The physician will decide the level of positive expiratory pressure and of pressure support.

Interventions

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AVAPS-AE mode during NIV

NIV will be setup in AVAPS-AE mode, with a Trilogy ventilation device (Respironics, Murrysville, PA). The range of positive expiratory pressure will be set between 4 and 14 cmH2O. The range of inspiratory pressure support will be set between 14 and 24 cmH2. The target tidal volume will be set to achieve 8 to 10 mL/kg of ideal body weight (Size (m) \* Size (m) \* 23).

Intervention Type DEVICE

S/T mode during NIV

NIV will be setup in ST mode, with a Trilogy ventilation device (Respironics, Murrysville, PA).

The physician will decide the level of positive expiratory pressure and of pressure support.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patient of age
* Patient benefitting of social security
* Informed patient who signed the information note and the research enlighted consent form
* Admission in respiratory intensive care unit for an acid-hypercapnic exacerbation (defined by pH≤ 7,35)
* BMI ≥ 30kg/m2
* PaCO2 \> 6.5 kPa on blood gases at ICU admission

Exclusion Criteria

* Confirmed COPD with a spirometry (VEMS/CVF \< 70%)
* Pregnant women, or breast-feeding women
* Patient with a judiciary or administrative liberty deprivation
* Patients under guardianship
* Contraindication to NIV
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Rouen

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Antoine Cuvelier, MD, PhD

Role: STUDY_DIRECTOR

UH Rouen

Locations

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CHU Rouen

Rouen, , France

Site Status

Countries

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France

Other Identifiers

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2018/409/HP

Identifier Type: -

Identifier Source: org_study_id

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