Pneumonia, AspirationPhase 1NCT02301845
Validation of Aspiration Markers
A Phase 1 study testing Diatoms Shells in people with Pneumonia, Aspiration, run by Massachusetts General Hospital at 1 site in United States.
Trial summary
This is an interventional crossover study aimed at validating diatom shells as a marker for cuff leak and microaspiration in mechanically ventilated, critically ill patients. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Pneumonia, Aspiration
- What is being tested?
- Diatoms Shells
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 0 participants
- Where
- 1 siteUnited States
- Study dates
- Feb 2016to Mar 2016
- Phase
- Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age ≥ 18 years;
- Admission to Surgical ICUs (Ellison 4 or Blake 12);
- Patients expected to be intubated for at least 48 hours or longer from the time of enrollment.
Who cannot join
- High PEEP requirement at enrollment (PEEP higher than 8 cmH2O)
- Diagnosis of ARDS (any severity)
- Status asthmaticus
- Current or past participation in another interventional trial conflicting with the present study;
- Pregnant women;
- Prisoner status;
- Patients who had partial or total gastrectomy.
Trial locations and contacts
1 site in 1 country.
United States1 site
Massachusetts General Hospital
Boston, Massachusetts, 02114
About this study
Official title: Validation of a Marker for Aspiration and Endotracheal Tube Cuff Leak.
This is an interventional crossover study aimed at validating diatom shells as a marker for cuff leak and microaspiration in mechanically ventilated, critically ill patients.
Read the detailed description
At present there is no standard method for the evaluation of in vivo cuff leak and aspiration. Most of the tested techniques have major pitfalls that render their routine application infeasible. Lacking a practical and reliable marker, any possible intervention aimed at improving cuff seal and ETT performance in order to reduce VAP occurrence is going to be hindered by the inability to truly evaluate its efficacy. Radiolabeled markers are expensive, expose the patient to considerable radiological risk, and require transport to a radiological department, which would expose critically ill patients to additional risk. Dyes have the potential to give useful information about the presence of a cuff leak, but due to persistent staining of secretions, they do not allow continuous monitoring of aspiration. Amylase detection could be a good marker of aspiration, but its ability to detect aspiration is poor even when compared to pepsin. Pepsin and bile acids have the potential to detect some of the aspirations and cuff leaks that happen daily in mechanically ventilated patients, but due to their gastrointestinal nature, they do not offer any kind of information about aspiration of contaminated oropharyngeal secretions. With this research protocol, we would like to validate the use of diatom skeletons suspended in saline as a marker for determining cuff leakage and aspiration events in an ICU population and compare its efficacy in identifying aspiration events with pepsin detection. Diatoms are a major group of algae, composing the majority of phytoplankton. Their diameter is 5-15 μm on average and 1 ml of seawater usually contains about 104 diatoms. They are unicellular organisms and their main feature is that they are enclosed within a cell wall made of amorphous silica, biopolymerized in a geometric fashion that is species-dependent. At the end of their vital cycle, diatom shells deposit at the bottom of the sea. Diatom shell deposits have been found in almost every place on Earth, and are the main component of diatomaceous earth (DE). DE is an extremely fine powder composed of diatom shells that have accumulated over thousands of years. Due to its microscopical texture and inexpensive nature, it is commonly employed as a filtering media for beverages and a drying and anti-mold agent for cereals. Diatom shells compose food-grade DE in its entirety. Due to its non-crystalline, amorphous nature, it is essentially nontoxic. Our hypothesis is that administration of 10 mg of DE suspended in 10 ml of saline into the pharyngeal cavity of intubated patients will act as a reliable marker of cuff leak and aspiration in critically ill patients. Thanks to their geometric shape, diatom shells should be easily detectable in tracheal secretions when observed under a microscope. The number of diatoms-per-field observed under a fixed magnification will allow for the detection of microaspiration in a qualitative and quantitative way. The introduction of this new, safe and inexpensive marker for evaluating ETT cuff performance and for detecting aspiration will improve the design of future studies aimed at VAP prevention
- Conditions
- Pneumonia, Aspiration
- Being tested
- Diatoms Shells
- Keywords
- Respiration, artificial
- Medical subject headings
- Pneumonia, Aspiration, Respiratory Aspiration
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Diatoms ShellsDrug
Instillation of suspended diatom shells - 10 mg q12h
| Study group | Role | What they receive |
|---|---|---|
| Suspended Diatoms | Experimental | Suspended diatom shells (10 mg/ 10 ml of saline) will be instilled in the oral cavity of the study subject every 12 hours for the first three study days. The total amount of amorphous silica administered will be 20 mg/day, which is the average daily intake of amorphous silica in normal human diet (0.3 mg/kg body weight/day) Receives: Drug: Diatoms Shells |
What is being measured
The primary outcome is the main question the study is designed to answer.
Cuff leak and microaspiration
The investigators will collect samples of tracheal secretions below the cuff every 4 hours after the first pharyngeal administration of diatom shells and after 12 hours from the other 5 scheduled administrations of diatom shells. Samples will be centrifuged and the sediment observed under microscopy for detection of shells in tracheal secretions below the endotracheal tube cuff. Their presence will be a sign of cuff leak and aspiration. The ratio between administered diatom shells and collected diatom shells will be used to give an estimate of leakage.
Measured: 3 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted26 Nov 2014 (estimated)
- Study startFeb 2016
- Primary completionMar 2016 (estimated)
- Study completionMar 2016 (estimated)
Why it stopped: IRB disapproval
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Pneumonia, AspirationStudies of the same condition, open and under way.
- More trials run by Massachusetts General HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Diagnosis
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- Massachusetts General Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Lorenzo Berra, MD, Massachusetts General Hospital
- Investigators
- Lorenzo Berra, MD, Principal investigator, Massachusetts General Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02301845
- Sponsor's protocol ID
- Creatures
- Status last verified
- Mar 2016
- First submitted
- 23 Nov 2014
- Last updated
- 16 Mar 2016
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 16 Mar 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Validation of a Marker for Aspiration and Endotracheal Tube Cuff Leak.
- ClinicalTrials.gov ID
- NCT02301845
- Acronym / sponsor ID
- Creatures
- Conditions
- Pneumonia, Aspiration
- Keywords
- Respiration, artificial
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- WithdrawnReason stopped: IRB disapproval
- Enrolment
- 0 participants (actual)
- Lead sponsor
- Massachusetts General HospitalUniversity, hospital or other
- Study start
- Feb 2016
- Primary completion
- Mar 2016 (estimated)
- Study completion
- Mar 2016 (estimated)
- First posted
- 26 Nov 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is an interventional crossover study aimed at validating diatom shells as a marker for cuff leak and microaspiration in mechanically ventilated, critically ill patients.
Detailed description
At present there is no standard method for the evaluation of in vivo cuff leak and aspiration. Most of the tested techniques have major pitfalls that render their routine application infeasible. Lacking a practical and reliable marker, any possible intervention aimed at improving cuff seal and ETT performance in order to reduce VAP occurrence is going to be hindered by the inability to truly evaluate its efficacy. Radiolabeled markers are expensive, expose the patient to considerable radiological risk, and require transport to a radiological department, which would expose critically ill patients to additional risk. Dyes have the potential to give useful information about the presence of a cuff leak, but due to persistent staining of secretions, they do not allow continuous monitoring of aspiration. Amylase detection could be a good marker of aspiration, but its ability to detect aspiration is poor even when compared to pepsin. Pepsin and bile acids have the potential to detect some of the aspirations and cuff leaks that happen daily in mechanically ventilated patients, but due to their gastrointestinal nature, they do not offer any kind of information about aspiration of contaminated oropharyngeal secretions. With this research protocol, we would like to validate the use of diatom skeletons suspended in saline as a marker for determining cuff leakage and aspiration events in an ICU population and compare its efficacy in identifying aspiration events with pepsin detection. Diatoms are a major group of algae, composing the majority of phytoplankton. Their diameter is 5-15 μm on average and 1 ml of seawater usually contains about 104 diatoms. They are unicellular organisms and their main feature is that they are enclosed within a cell wall made of amorphous silica, biopolymerized in a geometric fashion that is species-dependent. At the end of their vital cycle, diatom shells deposit at the bottom of the sea. Diatom shell deposits have been found in almost every place on Earth, and are the main component of diatomaceous earth (DE). DE is an extremely fine powder composed of diatom shells that have accumulated over thousands of years. Due to its microscopical texture and inexpensive nature, it is commonly employed as a filtering media for beverages and a drying and anti-mold agent for cereals. Diatom shells compose food-grade DE in its entirety. Due to its non-crystalline, amorphous nature, it is essentially nontoxic. Our hypothesis is that administration of 10 mg of DE suspended in 10 ml of saline into the pharyngeal cavity of intubated patients will act as a reliable marker of cuff leak and aspiration in critically ill patients. Thanks to their geometric shape, diatom shells should be easily detectable in tracheal secretions when observed under a microscope. The number of diatoms-per-field observed under a fixed magnification will allow for the detection of microaspiration in a qualitative and quantitative way. The introduction of this new, safe and inexpensive marker for evaluating ETT cuff performance and for detecting aspiration will improve the design of future studies aimed at VAP prevention
Study design
- Primary purpose
- Diagnosis
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Suspended Diatoms | Experimental | Drug: Diatoms ShellsSuspended diatom shells (10 mg/ 10 ml of saline) will be instilled in the oral cavity of the study subject every 12 hours for the first three study days. The total amount of amorphous silica administered will be 20 mg/day, which is the average daily intake of amorphous silica in normal human diet (0.3 mg/kg body weight/day) |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Age ≥ 18 years;
- Admission to Surgical ICUs (Ellison 4 or Blake 12);
- Patients expected to be intubated for at least 48 hours or longer from the time of enrollment.
Key exclusion criteria (7 listed)
- High PEEP requirement at enrollment (PEEP higher than 8 cmH2O)
- Diagnosis of ARDS (any severity)
- Status asthmaticus
- Current or past participation in another interventional trial conflicting with the present study;
- Pregnant women;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Diatoms ShellsInstillation of suspended diatom shells - 10 mg q12h | Drug | Suspended Diatoms |
Primary outcome
Cuff leak and microaspiration
Time frame: 3 days
The investigators will collect samples of tracheal secretions below the cuff every 4 hours after the first pharyngeal administration of diatom shells and after 12 hours from the other 5 scheduled administrations of diatom shells. Samples will be centrifuged and the sediment observed under microscopy for detection of shells in tracheal secretions below the endotracheal tube cuff. Their presence will be a sign of cuff leak and aspiration. The ratio between administered diatom shells and collected diatom shells will be used to give an estimate of leakage.
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 Mar 2016.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Lorenzo Berra, MD principal investigator
Massachusetts General Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing Diatoms Shells in people with Pneumonia, Aspiration, run by Massachusetts General Hospital at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: withdrawn, as of the sponsor's last update on 16 Mar 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study was withdrawn before enrolling participants, so there are no results.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Cuff leak and microaspiration (time frame: 3 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Mar 2016.