Jet or Vibrating Mesh Nebulisation for Secretion Management in ICU

NCT ID: NCT05635903

Last Updated: 2023-02-02

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

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-12-22

Study Completion Date

2023-12-22

Brief Summary

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Critically unwell patients in Intensive Care have a decreased ability to effectively clear secretions. High secretion load is a major risk factor in the failure of tracheal extubation failure and the requirement for reintubation. Extubation failure is a predictor of poor outcome independent of the severity of the underlying illness. Nebulisation of isotonic saline can be employed to manage secretions by reducing the secretion viscosity and facilitating clearance of respiratory sections during tracheal suction.

Standard jet nebulisers have been the mainstay of respiratory section management therapy in critical care since the early 1990s. A more recent development has been the vibrating mesh nebuliser. There is evidence of improved humidification and reduced water particle size and theoretically better transfer to the distal airways.

Detailed Description

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1.2 Rationale The vibrating mesh nebuliser (Aerogen technology) may be superior to standard nebuliser technology.

1.3 Study hypothesis Improved secretion management with reduced tenacity of respiratory sections and potentially improved lung physiology secondary to improved humidification or reduced size of nebulised particles? 2. STUDY OBJECTIVES

Primary Endpoint Pourability of respiratory secretions (As assessed by the Qualitative Sputum Assessment Tool)

(The QSA score will assess quantity, quality/stickiness/density and colour/appearance of secretions and is described and validated in the literature3,4)

Secondary endpoints

* Volume of secretions (increased or decreased may be beneficial)
* Work of breathing
* Airway resistance
* Number of number of additional nebulised doses of saline or other drugs administered during the study period
* Ease of sampling, in the opinion of treating nurse
* Frequency of requiring changing the HME(heat and moisture exchange) filter
* Length of time on ventilator
* Length of stay in ICU/HDU(Intensive care unit/high dependancy unit)
* ICU Mortality

3\. STUDY DESIGN 3.1 Study Population

A total of 60 patients will be recruited to the study. Each patient will be randomised to receive:

Continuous nebulisation of 0.9% normal saline using the Aerogen Solo Nebuliser (50mls/24h via a syringe feed set) OR

Intermittent nebulisation of 0.9% normal saline using the Aerogen Solo Nebuliser (5mls, 6 hourly) OR

Intermittent standard nebulisation of 0.9% normal saline using the Intersurgical Cirrus 2 self-sealing Jet Nebuliser (5 mls, 6 hourly)

Conditions

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Respiratory Failure Critical Illness

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Continuous nebulisation 0.9% saline Aerogen Solo vibrating mesh Nebuliser

Continuous nebulization of 0.9% normal saline using the Aerogen Solo Nebuliser (50mls/24h continuous infusion using a syringe pump)

Group Type EXPERIMENTAL

Continuous nebulisation 0.9% saline Aerogen Solo vibrating mesh Nebuliser

Intervention Type PROCEDURE

Continuous nebulisation of 0.9% saline using the Aerogen Solo vibrating mesh nebuliser

Intermittent nebulisation 0.9% saline Aerogen Solo vibrating mesh Nebuliser

Intermittent nebulization of 0.9% normal saline using the Aerogen Solo Nebuliser (5mls 0.9% normal saline nebulised every 6 hours)

Group Type EXPERIMENTAL

Intermittent nebulisation 0.9% saline Aerogen vibrating mesh Solo Nebuliser

Intervention Type PROCEDURE

Intermittent nebulisation of 0.9% saline using the Aerogen Solo vibrating mesh nebuliser

Intermittent standard nebulisation of 0.9% saline Intersurgical Cirrus 2 self sealing Jet Nebuliser

Intermittent standard nebulization of 0.9% normal saline using the Intersurgical Cirrus 2 self-sealing Jet Nebuliser ((5mls 0.9% normal saline nebulised every 6 hours)

Group Type ACTIVE_COMPARATOR

Intermittent standard intermittent nebulisation of 0.9% saline Intersurgical Cirrus 2 self sealing Jet Nebuliser

Intervention Type PROCEDURE

standard intermittent nebulisation of 0.9% saline using the Intersurgical Cirrus 2 self-sealing Jet Nebuliser

Interventions

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Continuous nebulisation 0.9% saline Aerogen Solo vibrating mesh Nebuliser

Continuous nebulisation of 0.9% saline using the Aerogen Solo vibrating mesh nebuliser

Intervention Type PROCEDURE

Intermittent nebulisation 0.9% saline Aerogen vibrating mesh Solo Nebuliser

Intermittent nebulisation of 0.9% saline using the Aerogen Solo vibrating mesh nebuliser

Intervention Type PROCEDURE

Intermittent standard intermittent nebulisation of 0.9% saline Intersurgical Cirrus 2 self sealing Jet Nebuliser

standard intermittent nebulisation of 0.9% saline using the Intersurgical Cirrus 2 self-sealing Jet Nebuliser

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patient aged 18-80 years at time of recruitment to study
* Ventilated via an endotracheal tube or tracheostomy with an HME filter in the circuit
* Secretion load defined as patient requiring suctioning at least 2 times in the 6 hours prior to recruitment
* Sputum viscosity with grades 1 to 3 pourability in the Qualitative Sputum Assessment tool
* Not yet received saline nebulisation in the 6 hours prior to recruitment
* Likely to be ventilated via an endotracheal tube or tracheostomy for at least 3 days in the opinion of the treating clinician

Exclusion Criteria

* Pregnancy
* Pulmonary embolus
* Heart Failure (NYHA Grade III/IV)
* Clinical evidence of frank pulmonary oedema
* Cardiovascular instability (systolic BP ≤75 or heart rate ≥140)
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Aerogen

INDUSTRY

Sponsor Role collaborator

NHS Greater Glasgow and Clyde

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Malcolm Sim, MBcHB

Role: PRINCIPAL_INVESTIGATOR

nhs GGC health board

Locations

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Queen Elizabeth University Hospital

Glasgow, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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malcolm SIm, MBChB

Role: CONTACT

01414523430

malcolm watson, MBCHB

Role: CONTACT

01414523430

Facility Contacts

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Malcolm Sim, MB ChB

Role: primary

01414523430

Malcolm j watson, MBchB

Role: backup

01414523430

References

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Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013 Jun 15;187(12):1294-302. doi: 10.1164/rccm.201208-1523CI.

Reference Type BACKGROUND
PMID: 23641924 (View on PubMed)

Terzi N, Guerin C, Goncalves MR. What's new in management and clearing of airway secretions in ICU patients? It is time to focus on cough augmentation. Intensive Care Med. 2019 Jun;45(6):865-868. doi: 10.1007/s00134-018-5484-2. Epub 2018 Dec 5. No abstract available.

Reference Type RESULT
PMID: 30519901 (View on PubMed)

Jaber S, Quintard H, Cinotti R, Asehnoune K, Arnal JM, Guitton C, Paugam-Burtz C, Abback P, Mekontso Dessap A, Lakhal K, Lasocki S, Plantefeve G, Claud B, Pottecher J, Corne P, Ichai C, Hajjej Z, Molinari N, Chanques G, Papazian L, Azoulay E, De Jong A. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures. Crit Care. 2018 Sep 23;22(1):236. doi: 10.1186/s13054-018-2150-6.

Reference Type RESULT
PMID: 30243304 (View on PubMed)

Keal EE, Reid L. Neuraminic acid content of sputum in chronic bronchitis. Thorax. 1972 Nov;27(6):643-53. doi: 10.1136/thx.27.6.643.

Reference Type RESULT
PMID: 4647626 (View on PubMed)

Lopez-Vidriero MT, Charman J, Keal E, De Silva DJ, Reid L. Sputum viscosity: correlation with chemical and clinical features in chronic bronchitis. Thorax. 1973 Jul;28(4):401-8. doi: 10.1136/thx.28.4.401.

Reference Type RESULT
PMID: 4741442 (View on PubMed)

Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics 2005; 4(4): 287-291.

Reference Type RESULT

Arnott A, Hart R, McQueen S, Watson M, Sim M. Prospective randomised unblinded comparison of sputum viscosity for three methods of saline nebulisation in mechanically ventilated patients: A pilot study protocol. PLoS One. 2023 Aug 17;18(8):e0290033. doi: 10.1371/journal.pone.0290033. eCollection 2023.

Reference Type DERIVED
PMID: 37590203 (View on PubMed)

Other Identifiers

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GN18RM440

Identifier Type: -

Identifier Source: org_study_id

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