OPEP Devices in Acute Inpatient Treatment of Pneumonia

NCT ID: NCT04540510

Last Updated: 2021-09-24

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

11 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-08-13

Study Completion Date

2021-02-18

Brief Summary

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This is a randomized-controlled prospective study to be conducted at Danbury Hospital and Norwalk Hospital to evaluate oscillatory positive expiratory pressure (OPEP) devices for "airway clearance" (helping to clear out phlegm or mucous from your lungs and bronchial tubes) in the treatment of patients admitted to the hospital with pneumonia.

Approximately 200 subjects are expected to participate in this study.

Detailed Description

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Pneumonia is one of the most common health conditions leading to hospitalization today. Approximately 1.3 million people in the US are admitted to the hospital with community-acquired pneumonia (CAP) annually, with readmission rates within the first 30 days as high as 20%. In a retrospective analysis of patients with culture-confirmed bacterial pneumonia, 30-day readmission occurred in 19.3% of patients. At Norwalk Hospital, the 30-day readmission rate for patients with pneumonia is 13.1%. CAP is the sixth most common cause of death with a case-fatality rate of up to 16% for hospitalized CAP patients, and an overall 30-day mortality up to 23%. The economic burden of CAP is also high, l with a CAP cost burden estimated to be at least $13 billion in 2008 within just the Medicare population.

There have been several small studies done to analyze the utility of airway clearance and its potential role in CAP. These studies have generally been small and have used a wide variety of airway clearance devices and techniques, including external chest wall physiotherapy devices and postural drainage, both now considered second line therapies for most patients. These studies have been variable in their findings and overall have not shown that airway clearance is either beneficial or harmful in CAP. The studies did show, however, that the duration of fever and hospital length of stay were both significantly decreased, suggesting the possibility of other clinically important benefits.

In this prospective randomized controlled trial, investigators will test the hypothesis that the use of OPEP devices, specifically the handheld Aerobika (Monaghan Medical) will result in more rapid and durable recovery in patients hospitalized with community-acquired pneumonia as measured by decreased hospital length of stay, reduced duration of fever, improvement in dyspnea, decreased duration of antibiotics, increased rate of diagnosis of the etiologic organism responsible for the pneumonia, and reduced readmission rates:

Primary outcome

1\. Reduction in hospital length of stay

Secondary outcomes

1. Reduction in dyspnea by modified-Borg score
2. Reduction in duration of antibiotics
3. Reduction in duration of fever
4. Reduction in need for oxygen at hospital discharge
5. Reduction in 30-, 60-, and 90-day readmission rates
6. Diagnosis of organism by sputum
7. Transfer to the intensive care unit (ICU)

Conditions

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Community-acquired Pneumonia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients randomized to the OPEP therapy added to standard pneumonia care OR standard pneumonia care..
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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OPEP therapy added to standard pneumonia care

The intervention group will be asked to use an OPEP device twice daily, with the help of study investigators, for a total of at least 5 minutes per session. This treatment will be in addition to the usual care that the hospital physician prescribe for them to treat the pneumonia.

Group Type ACTIVE_COMPARATOR

OPEP therapy

Intervention Type DEVICE

Oscillatory Positive Expiratory Pressure therapy

Standard care

Intervention Type OTHER

Standard pneumonia care

Standard pneumonia care

The control group will continue to receive the usual care that their hospital team prescribe for them to treat the pneumonia.

Group Type ACTIVE_COMPARATOR

Standard care

Intervention Type OTHER

Standard pneumonia care

Interventions

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OPEP therapy

Oscillatory Positive Expiratory Pressure therapy

Intervention Type DEVICE

Standard care

Standard pneumonia care

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Clinical symptoms suggesting pneumonia (eg. cough, fever, pleuritic chest pain, sputum production, dyspnea)
* Any new chest radiographic infiltrate consistent with pneumonia

Exclusion Criteria

* Untreated or recently (within the past 90 days) treated pneumothorax
* Active hemoptysis
* Recent facial, oral, or skull trauma
* Hemodynamically unstable patients
* Severe nausea or active vomiting
* Recent diagnosis of pneumonia prior to current inpatient encounter (within 60 days)
* Significant cognitive impairment or psychiatric conditions that prevent ability to participate in or cooperate with oPEP use
* Active TB or in negative pressure room
* Pregnancy
* Pre-existing medical condition with a life expectancy of less than 3 months
* Inability to form appropriate mouth seal on device (eg. due to neuromuscular disease)
* Pre-existing active use of oPEP devices
* Requiring \>=50% FiO2 or facemask (excluding high flow NC)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Danbury Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Amy Ahasic, MD

Role: PRINCIPAL_INVESTIGATOR

Nuvance Health

Locations

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Norwalk Hospital

Norwalk, Connecticut, United States

Site Status

Countries

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United States

References

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Yang M, Yan Y, Yin X, Wang BY, Wu T, Liu GJ, Dong BR. Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD006338. doi: 10.1002/14651858.CD006338.pub3.

Reference Type BACKGROUND
PMID: 23450568 (View on PubMed)

Narula D, Nangia V. Use of an oscillatory PEP device to enhance bronchial hygiene in a patient of post-H1NI pneumonia and acute respiratory distress syndrome with pneumothorax. BMJ Case Rep. 2014 Mar 7;2014:bcr2013202598. doi: 10.1136/bcr-2013-202598.

Reference Type BACKGROUND
PMID: 24717858 (View on PubMed)

Graham WG, Bradley DA. Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia. N Engl J Med. 1978 Sep 21;299(12):624-7. doi: 10.1056/NEJM197809212991203.

Reference Type BACKGROUND
PMID: 355879 (View on PubMed)

Christensen EF, Nedergaard T, Dahl R. Long-term treatment of chronic bronchitis with positive expiratory pressure mask and chest physiotherapy. Chest. 1990 Mar;97(3):645-50. doi: 10.1378/chest.97.3.645.

Reference Type BACKGROUND
PMID: 2106412 (View on PubMed)

Halm EA, Fine MJ, Marrie TJ, Coley CM, Kapoor WN, Obrosky DS, Singer DE. Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA. 1998 May 13;279(18):1452-7. doi: 10.1001/jama.279.18.1452.

Reference Type BACKGROUND
PMID: 9600479 (View on PubMed)

Sato R, Gomez Rey G, Nelson S, Pinsky B. Community-acquired pneumonia episode costs by age and risk in commercially insured US adults aged >/=50 years. Appl Health Econ Health Policy. 2013 Jun;11(3):251-8. doi: 10.1007/s40258-013-0026-0.

Reference Type BACKGROUND
PMID: 23605251 (View on PubMed)

File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med. 2010 Mar;122(2):130-41. doi: 10.3810/pgm.2010.03.2130.

Reference Type BACKGROUND
PMID: 20203464 (View on PubMed)

Khoudigian-Sinani S, Kowal S, Suggett JA, Coppolo DP. Cost-effectiveness of the Aerobika* oscillating positive expiratory pressure device in the management of COPD exacerbations. Int J Chron Obstruct Pulmon Dis. 2017 Oct 19;12:3065-3073. doi: 10.2147/COPD.S143334. eCollection 2017.

Reference Type BACKGROUND
PMID: 29089755 (View on PubMed)

De Alba I, Amin A. Pneumonia readmissions: risk factors and implications. Ochsner J. 2014 Winter;14(4):649-54.

Reference Type BACKGROUND
PMID: 25598730 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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18-1104

Identifier Type: -

Identifier Source: org_study_id

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