Individualization Flow in Patients Treated With High Flow Nasal Therapy (iFLOW)

NCT ID: NCT05401474

Last Updated: 2022-06-02

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

26 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-18

Study Completion Date

2023-02-28

Brief Summary

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In patients with acute hypoxemic respiratory failure (AHRF), High Flow Nasal Therapy (HFNT) improves oxygenation, tolerance, and decreases work of breathing as compared to standard oxygen therapy by facemask.

The hypothesis is that this flow challenge (ROX index variation from 30 to 60L/min) could be used as a test for assessing changes in lung aeration, analyzed by the variation in end expiratory lung volume (ΔEELV), in patients treated with HFNC. It may allow to personalize the flow settings during HFNC. In this sense, an increase in EELV will be observed with higher flows in responders and, therefore, these participants may benefit from increasing the flow. In contrast, to increase the flow in non-responders (no significant increase in EELV with higher flows) increase the risk of patient self-inflicted lung injury (P-SILI).

Detailed Description

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Conditions

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High-Flow Nasal Cannula Oxygen Therapy Acute Respiratory Failure Respiratory Failure Lung Injury

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants

Study Groups

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30 L/min

HFNC at 30L/min. FiO2 adjusted to reach SpO2 95%

Group Type ACTIVE_COMPARATOR

High Flow Nasal Cannula at 30L/min

Intervention Type DEVICE

Flow will be set at 30L/min, FiO2 will be adjusted manually to maintain SpO2within the target range

45 L/min

HFNC at 45L/min. FiO2 adjusted to reach SpO2 95%

Group Type EXPERIMENTAL

High Flow Nasal Cannula at 45L/min

Intervention Type DEVICE

Flow will be set at 45L/min, FiO2 will be adjusted manually to maintain SpO2within the target range

60 L/min

HFNC at 60L/min. FiO2 adjusted to reach SpO2 95%

Group Type EXPERIMENTAL

High Flow Nasal Cannula at 60L/min

Intervention Type DEVICE

Flow will be set at 60L/min, FiO2 will be adjusted manually to maintain SpO2within the target range

Interventions

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High Flow Nasal Cannula at 30L/min

Flow will be set at 30L/min, FiO2 will be adjusted manually to maintain SpO2within the target range

Intervention Type DEVICE

High Flow Nasal Cannula at 45L/min

Flow will be set at 45L/min, FiO2 will be adjusted manually to maintain SpO2within the target range

Intervention Type DEVICE

High Flow Nasal Cannula at 60L/min

Flow will be set at 60L/min, FiO2 will be adjusted manually to maintain SpO2within the target range

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Adult patient admitted to the ICU requiring NHF due to AHRF that will be defined as an SpO2/FIO2 ratio \<315

Exclusion Criteria

* Patient with indication for immediate CPAP, NIV, or invasive mechanical ventilation
* Hemodynamic instability defined as a need of continuous infusion of epinephrine or norepinephrine \> 1 mg/h
* Severe acidosis (pH ≤ 7.25)
* Pregnant woman
* Tracheotomised patient
* Formalized ethical decision to withhold or withdraw life support
* Patient under guardianship
* Patient deprived of liberties
* Patient already enrolled in the present study in a previous episode of acute respiratory failure
* Patient who does not consent.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Universitari Vall d'Hebron Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Hospital Universitari Vall d'Hebron

Barcelona, , Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Oriol Roca, MD PhD

Role: CONTACT

+34932746209

Francisco Ramos, MD

Role: CONTACT

+34932746209

Facility Contacts

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Oriol Roca, MD PhD

Role: primary

+34932746209

Francisco Ramos, MD

Role: backup

+34932746209

References

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Ricard JD, Roca O, Lemiale V, Corley A, Braunlich J, Jones P, Kang BJ, Lellouche F, Nava S, Rittayamai N, Spoletini G, Jaber S, Hernandez G. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med. 2020 Dec;46(12):2238-2247. doi: 10.1007/s00134-020-06228-7. Epub 2020 Sep 8.

Reference Type BACKGROUND
PMID: 32901374 (View on PubMed)

Mauri T, Alban L, Turrini C, Cambiaghi B, Carlesso E, Taccone P, Bottino N, Lissoni A, Spadaro S, Volta CA, Gattinoni L, Pesenti A, Grasselli G. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med. 2017 Oct;43(10):1453-1463. doi: 10.1007/s00134-017-4890-1. Epub 2017 Jul 31.

Reference Type BACKGROUND
PMID: 28762180 (View on PubMed)

Roca O, Messika J, Caralt B, Garcia-de-Acilu M, Sztrymf B, Ricard JD, Masclans JR. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care. 2016 Oct;35:200-5. doi: 10.1016/j.jcrc.2016.05.022. Epub 2016 May 31.

Reference Type BACKGROUND
PMID: 27481760 (View on PubMed)

Bachmann MC, Morais C, Bugedo G, Bruhn A, Morales A, Borges JB, Costa E, Retamal J. Electrical impedance tomography in acute respiratory distress syndrome. Crit Care. 2018 Oct 25;22(1):263. doi: 10.1186/s13054-018-2195-6.

Reference Type BACKGROUND
PMID: 30360753 (View on PubMed)

Other Identifiers

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PR(AG)21/2022

Identifier Type: -

Identifier Source: org_study_id

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