Postextubation Use of Noninvasive Respiratory Support in Severely Obese Patients

NCT ID: NCT05918575

Last Updated: 2025-10-20

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

250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-07-10

Study Completion Date

2026-12-01

Brief Summary

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Around 20% of the obese patients with higher body mass index (BMI) who are taken off the breathing tube and breathing machine (ventilator) end up needing it back to support breathing. The re-application of breathing tube is associated with poor outcomes, including high risk of pneumonia, longer hospital stays, and death. The purpose of this study is to assess if prophylactic use of noninvasive breathing support after removing the breathing tube lowers the chance of needing the breathing tube again.

Detailed Description

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Patients with obesity are at risk of developing respiratory failure due to reduced lung volumes and chest wall compliance. Obesity is one of the easily identifiable, contributing factors of extubation failure that often leads to prolonged mechanical ventilation use and ICU stay. The early application of noninvasive respiratory support, especially NIV, has been shown to reduce reintubation rates in obese patients in a small, non-randomized study. However, prolonged use of NIV is often associated with decreased patient compliance and increased incidence of skin breakdown. HFNC is a noninvasive strategy that is comfortable, uses a nasal cannula and provides a high flow rate to meet the patient's inspiratory flow demand and thereby reduce work of breathing.

The purpose of this RCT will be to determine the effects of using NIV alternating with HFNC for reducing the treatment failure rate compared with HFNC alone in extubated patients with severe obesity. We hypothesize that early, prophylactic use of NIV alternating with HFNC will decrease the risk of respiratory failure (treatment failure) in severely obese patients.

Conditions

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Obesity, Morbid Extubation Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Intervention Group (NIV with HFNC)

Patients randomized to the intervention group will receive NIV alternating with HFNC for 24 hours after extubation

Group Type EXPERIMENTAL

Noninvasive ventilation alternating with high flow nasal cannula

Intervention Type DEVICE

A total of 24 hours of prophylactic respiratory support will be provided using NIV alternating with HFNC with total NIV usage of 16 hours and HFNC usage of 8 hours.

Control Group (HFNC alone)

Patients randomized to the intervention group will receive HFNC only for 24 hours after extubation

Group Type ACTIVE_COMPARATOR

High flow nasal cannula

Intervention Type DEVICE

A total of 24 hours of prophylactic respiratory support will be provided using HFNC alone.

Interventions

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Noninvasive ventilation alternating with high flow nasal cannula

A total of 24 hours of prophylactic respiratory support will be provided using NIV alternating with HFNC with total NIV usage of 16 hours and HFNC usage of 8 hours.

Intervention Type DEVICE

High flow nasal cannula

A total of 24 hours of prophylactic respiratory support will be provided using HFNC alone.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Adult, age ≥ 18 years old
2. Receiving invasive mechanical ventilation for ≥24 hours
3. BMI ≥40 kg/m2
4. Undergoing planned extubation per treating team
5. Arterial pH ≥7.35 or venous pH ≥ 7.31 within 30 mins of spontaneous breathing trial (SBT)

Exclusion Criteria

1. Pregnant
2. Use of extra-corporeal membrane oxygenation
3. Chronic tracheostomy in place
4. Unplanned or accidental extubation
5. Terminal/compassionate extubation
6. Contraindication to NIV use
7. Intubated because of an acute exacerbation of COPD
8. Underlying neuromuscular disease
9. No reintubation requested by patient/family
10. Documented/known history of chronic hypercapnic respiratory failure on home NIV (including bilevel PAP).
11. Enrolled in any other outcome study
12. Treating clinician feels that HFNC or NIV are either mandatory or contraindicated for a given patient
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Civil de Guadalajara

OTHER

Sponsor Role collaborator

Medical College of Wisconsin

OTHER

Sponsor Role collaborator

The University of Texas Health Science Center, Houston

OTHER

Sponsor Role collaborator

Central DuPage Hospital

OTHER

Sponsor Role collaborator

Rush University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Ramandeep Kaur

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ramandeep Kaur, PhD

Role: PRINCIPAL_INVESTIGATOR

Rush University Medical Center

Babak Mokhlesi, MD

Role: PRINCIPAL_INVESTIGATOR

Rush University Medical Center

Locations

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Rush University Medical Center

Chicago, Illinois, United States

Site Status RECRUITING

Central DuPage Hospital

Winfield, Illinois, United States

Site Status NOT_YET_RECRUITING

McGovern Medical School, The University of Texas Health Science Center

Houston, Texas, United States

Site Status RECRUITING

Medical College of Wisconsin

Milwaukee, Wisconsin, United States

Site Status RECRUITING

Hospital Civil Fray Antonio Alcalde

Guadalajara, Jalisco, Mexico

Site Status RECRUITING

Countries

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United States Mexico

Central Contacts

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Ramandeep Kaur, PhD

Role: CONTACT

3129478898

Babak Mokhlesi, MD

Role: CONTACT

(312) 563-0843

Facility Contacts

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Ramandeep Kaur, PhD

Role: primary

Babak Mokhlesi, MD

Role: backup

Ankeet Patel

Role: primary

Rosa M. Estrada-Y-Martin, MD

Role: primary

Rahul Nanchal, MD

Role: primary

Miguel Ángel Ibarra Estrada

Role: primary

Other Identifiers

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23050803

Identifier Type: -

Identifier Source: org_study_id

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