Continous Positive Airway Pressure (CPAP) Support for Acute Hypoxemic Respiratory Failure in Burkina Faso

NCT ID: NCT06912360

Last Updated: 2025-07-28

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

240 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-09

Study Completion Date

2026-02-20

Brief Summary

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Acute respiratory failure (ARF) is a frequent medical emergency, involving high costs for health organizations and patients who often require intensive care and respiratory assistance. According to an international study, 61% of hypoxemic patients in intensive care receive invasive ventilation \[3\]. Invasive mechanical ventilation is often unavailable in low-income countries and non-invasive ventilatory supports such as continuous positive airway pressure (CPAP) and high-flow oxygen therapy (HFO) were very useful during the COVID-19 pandemic. They reduced the rate of intubation and ICU admissions. In addition, CPAP can be used without a ventilator, no electricity is required. So, it could be a support of choice in low-income countries.

Used of Boussignac-type CPAP could potentially reduce the recourse to intubation in patients with acute hypoxemic respiratory failure in a context where access to invasive ventilation remains very limited.

Detailed Description

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1. Hypothesis :

The use of Boussignac-type CPAP could reduce the need for intubation in patients with acute respiratory failure in a setting where access to invasive ventilation remains very limited.
2. Objectives

2.1 Primary Objective

The primary objective is to evaluate the effect of CPAP use on the occurrence of intubation criteria at 7 days in patients presenting with ARF in the emergency department.

2.2 Secondary Objectives

The secondary objectives are:
* To assess the impact of CPAP use on 28-day mortality in patients with ARF
* To assess the effectiveness of CPAP use on oxygenation in patients with ARF using the SpO2/FiO2 ratio
* To assess the impact of CPAP use on hospital stay
* To assess the safety of CPAP in patients with ARF

2.3 Ancillary Studies

The ancillary studies are:
* To assess the contribution of ultrasound in the management of ARF
* To determine the etiologies and prognosis of ARF
* To determine the etiologies and prognosis of patients with ARDS in intensive care
* To assess the cost of ARF management
3. Methodology 3.1 Study Setting

The Study will take place in the four adult university hospitals in Burkina Faso. Patient recruitment will take place during the same period in the emergency and intensive care departments. Patient inclusion in each hospital will be under the responsibility of an emergency department physician or an anesthesiologist-intensive care physician.

3.2 Study Type

This will be an open-label, multicenter, national randomized clinical trial. The type of oxygenation device does not allow for a blinded study.

3.3 Study Designs

Within 3 hours of validating the inclusion criteria, patients will be assigned to one of the two groups after signing the consent form.

* In both groups, the oxygen flow will be adjusted to achieve an SpO2 of 92% or higher. SpO2 will be measured either using a monitor with integrated SpO2 measurement or using a portable device such as the Lifebox. The remainder of the patient's care will be administered according to the etiology of the ARF at the physician's discretion and according to recommandations. Any omission from the administration of study treatment will be noted on the collection sheet.
* In the standard group Patients assigned to the standard treatment group will receive oxygen delivered via nasal prongs, simple face masks, or a high-concentration face mask (as needed) until intubation criteria are met, death occurs, or oxygen discontinuation criteria are met (an SpO2 greater than 92% without oxygen and a respiratory rate less than 25 breaths/min).

Patients who meet the intubation criteria will either be intubated if a bed and a ventilator are available in intensive care, or may receive, at the discretion of the physician, CPAP treatment as backup treatment in crossover, if invasive ventilation is not possible.

\- In the CPAP group Patients assigned to the CPAP plus oxygen group will receive periods of CPAP in addition to standard oxygen therapy. All study centers will use a Boussignac device connected to an oronasal mask consisting of a transparent mask and a soft inflatable cushion. The CPAP pressure level will be determined by the oxygen flow rate according to the correlation table. CPAP will start at 7.5 cmH2O (i.e., a Boussignac supply of 25 L/min). The pressure level will be decreased to 5 cmH2O (i.e., a Boussignac supply of 20 L/min) or increased to 10 cmH2O (i.e., a Boussignac supply of 30 L/min) depending on clinical response and tolerance. For at least the first 6 to 12 hours, CPAP will be administered continuously, then intermittently (for at least 6 hours/day) depending on patient tolerance. CPAP will be continued until endotracheal intubation criteria are met, death occurs, or treatment is discontinued according to the following criteria: SpO2 greater than 92% and respiratory rate less than 25 breaths/min with 3 L of oxygen or less between CPAP sessions. The criteria for discontinuing oxygen administration will be the same as in the standard group.

Patients who meet the intubation criteria will either be intubated if a bed and ventilator are available in intensive care, or will continue CPAP treatment if invasive ventilation is not possible.

3.4 Stratification

Randomization will be stratified by study center and baseline hypoxemia status. Stratification block randomization will be performed using a centralized, secure electronic system.

Conditions

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Acute Respiratory Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

We will have two groups : an interventional group and a standard of care group
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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CPAP group

Continuous CPAP (with Boussignac valve) for the first 6-12 hours, then alternating with standard oxygen therapy. CPAP pressure= 7.5 cmH2O (25L/min) then variations of +/- 2.5 cmH20 according to clinical response and tolerance until weaning from oxygen or presence of intubation criteria

Group Type EXPERIMENTAL

CPAP

Intervention Type OTHER

Continuous Positive Airway Pressure (CPAP) with Boussignac valve

Standard group

Oxygen therapy as required using, simple face masks or high concentration face masks until there are criteria for intubation, or withdrawal from oxygen.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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CPAP

Continuous Positive Airway Pressure (CPAP) with Boussignac valve

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

All patients aged 18 years and older will be included in the study if they meet at least one of the following criteria :

* Acute respiratory distress, defined as dyspnea respiratory rate ≥ 25 cycles/min
* Hypoxemia, defined as the need for more 6 liters of oxygen to maintain an oxygen saturation (SpO2) of ≥ 92%. The fraction of inspired oxygen (FiO2) will be estimated using the 3% rule.

Exclusion Criteria

Patients with any of the following criteria will not be included in the study:

* Pregnant or breastfeeding women
* Persons deprived of their liberty
* Exacerbation of asthma, chronic obstructive pulmonary disease, or another chronic respiratory disease
* Moderate to large amount of unilateral or bilateral undrained pleural effusion
* Contraindication to CPAP: patient refusal, undrained pneumothorax, chest injury, repeated or large vomiting, upper gastrointestinal bleeding, craniofacial trauma, severe upper airway obstruction, or tetraplegia in the initial phase
* Cardiac arrest, severe arrhythmias, shock requiring the use of vasopressors (norepinephrine, adrenaline, dopamine)
* Altered level of consciousness (Glasgow Coma Scale score \< 13), repeated seizures, or status epilepticus
* Medical decision to limit treatment: no intubation, no admission to intensive care
* Refusal to participate in the study or participation in another interventional study on respiratory distress or acute respiratory failure.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role collaborator

Université NAZI BONI

OTHER

Sponsor Role lead

Responsible Party

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Ismael Guibla

Clinical doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Armand Mekontso-dessap, professor

Role: STUDY_CHAIR

Assistance Publique - Hôpitaux de Paris

Ismael Guibla, doctor

Role: PRINCIPAL_INVESTIGATOR

University Hospital Souro Sanou, Burkina Faso

Ibrahim Alain Traore, professor

Role: STUDY_DIRECTOR

University Hospital Souro Sanou, Burkina Faso

Locations

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Centre Hospitalier Universitaire Souro Sanou

Bobo-Dioulasso, Houet, Burkina Faso

Site Status RECRUITING

CHU Yalgado Ouedraogo

Ouagadougou, Kadiogo, Burkina Faso

Site Status NOT_YET_RECRUITING

CHU Tengandogo

Ouagadougou, Kadiogo, Burkina Faso

Site Status NOT_YET_RECRUITING

CHU Bogodogo

Ouagadougou, Kadiogo, Burkina Faso

Site Status NOT_YET_RECRUITING

Countries

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Burkina Faso

Central Contacts

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Ismael Guibla, doctor

Role: CONTACT

+22676135113

Ibrahim Alain Traore, professor

Role: CONTACT

+22671457580

Facility Contacts

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Adama Decard Sawadogo, doctor

Role: primary

+22667337419

Ismael Guibla, doctor

Role: backup

+22676135113

Martin Lankoande, doctor

Role: primary

+22670606447

Papougnezambo Bonkoungou, doctor

Role: backup

+22670415444

Imbe Ignace Yaro, doctor

Role: primary

+22670675148

Flavien Kabore, professor

Role: backup

+22670142327

Seif Idriss Salah Traore, doctor

Role: primary

+22670689698

Chamir Congo, doctor

Role: backup

+22673380662

References

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Markou NK, Myrianthefs PM, Baltopoulos GJ. Respiratory failure: an overview. Crit Care Nurs Q. 2004 Oct-Dec;27(4):353-79. doi: 10.1097/00002727-200410000-00006.

Reference Type RESULT
PMID: 15537123 (View on PubMed)

Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Steingrub JS, Lagu T, Lindenauer PK. Epidemiology and outcomes of acute respiratory failure in the United States, 2001 to 2009: a national survey. J Hosp Med. 2013 Feb;8(2):76-82. doi: 10.1002/jhm.2004. Epub 2013 Jan 18.

Reference Type RESULT
PMID: 23335231 (View on PubMed)

SRLF Trial Group. Hypoxemia in the ICU: prevalence, treatment, and outcome. Ann Intensive Care. 2018 Aug 13;8(1):82. doi: 10.1186/s13613-018-0424-4.

Reference Type RESULT
PMID: 30105416 (View on PubMed)

Perkins GD, Ji C, Connolly BA, Couper K, Lall R, Baillie JK, Bradley JM, Dark P, Dave C, De Soyza A, Dennis AV, Devrell A, Fairbairn S, Ghani H, Gorman EA, Green CA, Hart N, Hee SW, Kimbley Z, Madathil S, McGowan N, Messer B, Naisbitt J, Norman C, Parekh D, Parkin EM, Patel J, Regan SE, Ross C, Rostron AJ, Saim M, Simonds AK, Skilton E, Stallard N, Steiner M, Vancheeswaran R, Yeung J, McAuley DF; RECOVERY-RS Collaborators. Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial. JAMA. 2022 Feb 8;327(6):546-558. doi: 10.1001/jama.2022.0028.

Reference Type RESULT
PMID: 35072713 (View on PubMed)

Templier F, Dolveck F, Baer M, Chauvin M, Fletcher D. [Laboratory testing measurement of FIO2 delivered by Boussignac CPAP system with an input of 100% oxygen]. Ann Fr Anesth Reanim. 2003 Feb;22(2):103-7. doi: 10.1016/s0750-7658(02)00859-6. French.

Reference Type RESULT
PMID: 12706763 (View on PubMed)

Other Identifiers

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INSSA 4

Identifier Type: -

Identifier Source: org_study_id

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