Mechanical Insufflation-exsufflation and Hypertonic Saline in Nosocomial Bacterial Respiratory Tract Infection

NCT ID: NCT06310941

Last Updated: 2025-03-26

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-01

Study Completion Date

2027-12-30

Brief Summary

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Multicenter, randomized open label clinical trial to evaluate IEM and HS as concomitant therapy for respiratory tract infection in patients under artificial ventilation in the ICU.

Lung infection is a serious complication that may occur during hospital stay and may need artificial respiration or even develop during artificial ventilation for other causes.

Current specific treatment consists of intravenous antibiotics. The current study evaluated whether aspiration and drainage of infected sputum helps curing this severe complication and whether nebulized HS has additional benefits, like loosening of secretions, eradicating bacteria or reducing inflammation.

Detailed Description

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Open label, randomized, multicenter (7 ICUs at 7 hospitals in Spain). The study has 2 main arms, pneumonia and tracheobronchitis.

If the diagnosis is pneumonia, subjects will be randomization to one of 3 study groups:

1. IV Antibiotic therapy
2. IV Antibiotic therapy + mechanical insufflation-Exsugglation (MI-E)
3. IV Antibiotic therapy + MI-E + nebulized hypertonic saline-hyaluronic acid (HS)

If the diagnosis is tracheobronchitis,subjects will be randomization to one of 3 study groups:

1. No specific therapy (recommendation of the Infectious Diseases Society of America)
2. IV Antibiotic therapy (common practice to prevent progressión to pneumona and shorten duration of intubation)
3. MI-E + HS

Safety will be compared by number of adverse events, severe adverse events and mortality between study groups in each main arm. Efficacy will be compared by duration of respiratory support and number of cases with worsening organ dysfunction.

Conditions

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Nosocomial Infection Nosocomial Pneumonia Tracheobronchitis Mechanical Ventilation Complication Endotracheal Intubation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

multicenter, randomized, open label
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Standard of Care

Standard of care: Systemic antibiotic therapy according to local protocol and at the discretion of the attending intensivist.

Group Type ACTIVE_COMPARATOR

Standard of Care

Intervention Type OTHER

systemic antibiotic therapy and catheter suctioning of secretions as recommended by guidelines

Mechanical insufflation-exsufflation with hypertonic saline/hyaluronic acid comination

Systemic antibiotic therapy choice according to local protocol and at the discretion of the attending intensivist plus Mechanical insufflation-exsufflation (MI-E sessión tid during the first 48 hours, followed by MI-E if secretions are present or suspected; recommended settings +50 cmH2O/-50 cmH2O) with simultaneous nebulization of hypertonic saline (7%) with hyaluronic acid (0.1%).

Group Type EXPERIMENTAL

Mechanical insufflation-exsufflation

Intervention Type DEVICE

Combined use of mechanical insufflation-exsufflation with nebulized hypertonic saline in intubated patients with nosocomial respiratory tract infection

Hypertonic saline with hyaluronic acid

Intervention Type OTHER

Commercially available combination of 7% hypertonic saline with 0.1% hyaluronic acid given as nebulization during the MI-E session

Mechanical insufflation-exsufflation

Systemic antibiotic therapy choice according to local protocol and at the discretion of the attending intensivist plus Mechanical insufflation-exsufflation (MI-E sessión tid during the first 48 hours, followed by MI-E if secretions are present or suspected; recommended settings +50 cmH2O/-50 cmH2O)

Group Type EXPERIMENTAL

Mechanical insufflation-exsufflation

Intervention Type DEVICE

Combined use of mechanical insufflation-exsufflation with nebulized hypertonic saline in intubated patients with nosocomial respiratory tract infection

Interventions

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Mechanical insufflation-exsufflation

Combined use of mechanical insufflation-exsufflation with nebulized hypertonic saline in intubated patients with nosocomial respiratory tract infection

Intervention Type DEVICE

Standard of Care

systemic antibiotic therapy and catheter suctioning of secretions as recommended by guidelines

Intervention Type OTHER

Hypertonic saline with hyaluronic acid

Commercially available combination of 7% hypertonic saline with 0.1% hyaluronic acid given as nebulization during the MI-E session

Intervention Type OTHER

Other Intervention Names

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Cough Assist Routine care of respiratory tract infection (Hyaneb-TM)

Eligibility Criteria

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Inclusion Criteria

* Signed informed consent
* Nosocomial pneumonia (vHAP or VAP) or nosocomial tracheobronchitis
* Intubated with a cuffed endotracheal tube or tracheostomy cannula.

Exclusion Criteria

* Ominous prognosis
* Frank hemoptisis
* Barotrauma (pneumothorax or pneumomediastinum)
* Bronchospasm (patients on bronchodilators for previous bronchospasm may be included
* Unstable thoracic cage
* Suspected unmonitored intracraneal hypertension
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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FUNDACION PARA LA INVESTIGACION HOSPITAL CLINICO SAN CARLOS

OTHER

Sponsor Role collaborator

Hospital San Carlos, Madrid

OTHER

Sponsor Role lead

Responsible Party

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Miguel Sanchez Garcia

Emeritus Critical Care Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Belén De la Hera Hernanz, PhD

Role: STUDY_DIRECTOR

Hospial Clinico San Carlos

Locations

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Hospital Vall d´Hebrón.

Barcelona, Barcelona, Spain

Site Status

Hospital Nuestra Señora de la Candelaria.

Santa Cruz de Tenerife, Las Palmas, Spain

Site Status

Hospital Clinico San Carlos

Madrid, Madrid, Spain

Site Status

Hospital Clínico San Carlos

Madrid, Madrid, Spain

Site Status

Hospital de la Princesa

Madrid, Madrid, Spain

Site Status

Hospital Doce de Octubre

Madrid, Madrid, Spain

Site Status

Hospital Álvaro Cunqueiro.

Vigo, Pontevedra, Spain

Site Status

Virgen de la Salud

Toledo, Toledo, Spain

Site Status

Countries

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Spain

Central Contacts

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Miguel Sánchez Garcia, MD. PhD.

Role: CONTACT

+34658762739

Belén De la Hera Hernanz, PhD

Role: CONTACT

+34650624550

Facility Contacts

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Xavier - Nuvials, MD, PhD

Role: primary

Ricard - Ferrer Roca, MD, PhD

Role: backup

Sergio - Rodríguez Ramos, MD

Role: primary

Miguel Sanchez-Garcia

Role: primary

658762739

Miguel Sanchez-Garcia, MD, PhD

Role: primary

+34658762739

Belén De la Hera Hernanz, PhD

Role: backup

Aris - Pérez Lucendo

Role: primary

Dolores - Rodríguez Huerta

Role: backup

María Cruz - Martín-Delgado, MD

Role: primary

Pilar Losada, MD, PhD

Role: primary

Dolores Vila, MD, PhD

Role: backup

Gonzalo Hernández, MD, PhD

Role: primary

References

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Sanchez-Garcia M, Alvarez-Gonzalez M, Domingo-Marin S, Pino-Ramirez AD, Martinez-Sagasti F, Gonzalez-Arenas P, Cardenal-Sanchez C, Velasco-Lopez E, Nunez-Reiz A. Comparison of Mechanical Insufflation-Exsufflation and Hypertonic Saline and Hyaluronic Acid With Conventional Open Catheter Suctioning in Intubated Patients. Respir Care. 2024 Apr 22;69(5):575-585. doi: 10.4187/respcare.11566.

Reference Type BACKGROUND
PMID: 38307525 (View on PubMed)

Ferreira de Camillis ML, Savi A, Goulart Rosa R, Figueiredo M, Wickert R, Borges LGA, Galant L, Teixeira C. Effects of Mechanical Insufflation-Exsufflation on Airway Mucus Clearance Among Mechanically Ventilated ICU Subjects. Respir Care. 2018 Dec;63(12):1471-1477. doi: 10.4187/respcare.06253. Epub 2018 Jul 17.

Reference Type BACKGROUND
PMID: 30018175 (View on PubMed)

Knudtzen FC, Sprehn M, Vestbo J, Johansen IS. Mechanical insufflation/exsufflation compared with standard of care in patients with pneumonia: A randomised controlled trial. Eur J Anaesthesiol. 2020 Nov;37(11):1077-1080. doi: 10.1097/EJA.0000000000001209. No abstract available.

Reference Type BACKGROUND
PMID: 33027229 (View on PubMed)

Sanchez-Garcia M, Santos P, Rodriguez-Trigo G, Martinez-Sagasti F, Farina-Gonzalez T, Del Pino-Ramirez A, Cardenal-Sanchez C, Busto-Gonzalez B, Requesens-Solera M, Nieto-Cabrera M, Romero-Romero F, Nunez-Reiz A. Preliminary experience on the safety and tolerability of mechanical "insufflation-exsufflation" in subjects with artificial airway. Intensive Care Med Exp. 2018 Apr 3;6(1):8. doi: 10.1186/s40635-018-0173-6.

Reference Type BACKGROUND
PMID: 29616357 (View on PubMed)

Other Identifiers

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Pending

Identifier Type: OTHER

Identifier Source: secondary_id

ABSENTA

Identifier Type: -

Identifier Source: org_study_id

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