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Respiratory FailurePreVentNCT03026322

Preventing Hypoxemia With Manual Ventilation During Endotracheal Intubation (PreVent) Trial

A study testing Manual Ventilation and No Manual Ventilation in people with Respiratory Failure and Respiratory Failure With Hypoxia, run by Vanderbilt University Medical Center at 5 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Complications are common during endotracheal intubation of critically ill adults. Manual ventilation between induction and intubation ("bag-valve-mask" ventilation) has been proposed as a means of preventing hypoxemia, the most common complication of intubation outside the operating room. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Manual Ventilation and No Manual Ventilation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
401 participants
Where
5 sitesUnited States
Study dates
15 Mar 2017to 6 Jul 2018
Phase
Interventional
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

  • Patient is located in a participating unit
  • Planned procedure is endotracheal intubation
  • Planned operator is a provider expected to routinely perform endotracheal intubation in the participating unit
  • Administration of sedation and/or neuromuscular blockade is planned
  • Age ≥ 18 years old

Who cannot join

  • Urgency of intubation precludes safe performance of study procedures
  • Operator feels a specific approach to ventilation between induction and intubation is required
  • Pregnant women
  • Prisoners

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

United States5 sites
  • The University of Alabama at Birmingham

    Birmingham, Alabama, 35294

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37209

  • Louisiana State University School of Medicine

    New Orleans, Louisiana, 70112

  • Ochsner Health System

    New Orleans, Louisiana, 70121

  • Harborview Medical Center, University of Washington

    Seattle, Washington, 98104

Other trials in United States

About this study

Complications are common during endotracheal intubation of critically ill adults. Manual ventilation between induction and intubation ("bag-valve-mask" ventilation) has been proposed as a means of preventing hypoxemia, the most common complication of intubation outside the operating room. Safety and efficacy data, however, are lacking. PreVent is a randomized trial comparing manual ventilation between induction and laryngoscopy to no manual ventilation between induction an laryngoscopy during endotracheal intubation of critically ill adults. The primary efficacy endpoint will be the lowest arterial oxygen saturation. The primary safety endpoints will be the lowest oxygen saturation, highest fraction of inspired oxygen, and highest positive end-expiratory pressure in the 24 hours after the procedure.

Read the detailed description

PreVent is a prospective, parallel-group, pragmatic, randomized trial comparing manual ventilation between induction and laryngoscopy to no manual ventilation between induction an laryngoscopy during endotracheal intubation of critically ill adults. The primary aim of the PreVent trial is to compare the effect of manual ventilation between induction and intubation versus no manual ventilation on the lowest arterial oxygen saturation experienced by critically ill adults undergoing endotracheal intubation. The PreVent trial is anticipated to begin enrollment in January 2017 and will enroll adults undergoing endotracheal intubation with sedation and/or neuromuscular blockade in participating units. Patients will be randomized 1:1 to manual ventilation versus no manual ventilation. In the manual ventilation group, manual ventilation using a bag-valve-mask will be provided from the time of induction until the time of endotracheal intubation, except during laryngoscopy. In the no manual ventilation group, no manual ventilation will be provided between induction and endotracheal intubation, except for the treatment of hypoxemia. The primary efficacy endpoint will be the lowest arterial oxygen saturation during the procedure. The primary safety endpoints will be the lowest oxygen saturation, highest fraction of inspired oxygen, and highest positive end expiratory pressure in the 24 hours after intubation. Conduct of the trial will be overseen by a Data Safety Monitoring Board. An interim analysis will be performed after the enrollment of 175 patients. The analysis of the trial will be conducted in accordance with a pre-specified statistical analysis plan made publicly available prior to the conclusion of enrollment. The initial planned enrollment of 350 patients was increased by the Data and Safety Monitoring Board at the interim analysis to a final planned enrollment of 400 patients.

Being tested
Manual Ventilation, No Manual Ventilation
Medical subject headings
Respiratory Insufficiency

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Manual VentilationOther

    Also called Bag-valve-mask ventilation

    Beginning after the administration of sedation/neuromuscular blockade, manual ventilation will be provided by bag-valve-mask until the initiation of laryngoscopy. In patients requiring more than one attempt at laryngoscopy, bag-valve-mask ventilation will resume between laryngoscopy attempts.

  • No Manual VentilationOther

    Also called Apnea

    Between the administration of sedation/neuromuscular blockade and intubation, ventilation will not be provided unless the patient experiences an arterial oxygen saturation less than 90%. For patients who experience an oxygen saturation less than 90% after induction, bag-valve-mask ventilation may be provided.

Study groups in NCT03026322
Study groupRoleWhat they receive
Manual VentilationActive comparatorBeginning after the administration of sedation/neuromuscular blockade, manual ventilation will be provided by bag-valve-mask until the initiation of laryngoscopy. In patients requiring more than one attempt at laryngoscopy, bag-valve-mask ventilation will resume between laryngoscopy attempts.
Receives: Other: Manual Ventilation
No Manual VentilationActive comparatorBetween the administration of sedation/neuromuscular blockade and intubation, ventilation will not be provided unless the patient experiences an arterial oxygen saturation less than 90%. For patients who experience an oxygen saturation less than 90% after induction, bag-valve-mask ventilation may be provided.
Receives: Other: No Manual Ventilation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Lowest arterial oxygen saturation

    The lowest arterial oxygen saturation measured by continuous pulse oximetry (SpO2) between induction and 2 minutes after completion of the airway management procedure.

    Measured: Induction to 2 minutes after completion of the airway management procedure

Secondary outcomes (26)
  1. Incidence of lowest oxygen saturation less than 90%

    Incidence of lowest oxygen saturation less than 90% in the time from induction to 2 minutes after completion of the airway management procedure.

    Measured: Induction to 2 minutes after completion of the airway management procedure

  2. Incidence of lowest oxygen saturation less than 80%

    Incidence of lowest oxygen saturation less than 80% in the time from induction to 2 minutes after completion of the airway management procedure.

    Measured: Induction to 2 minutes after completion of the airway management procedure

  3. Change in saturation from induction to lowest oxygen saturation

    Change in saturation from induction to lowest oxygen saturation within 2 minutes after completion of the airway management procedure.

    Measured: Induction to 2 minutes after completion of the airway management procedure

  4. Incidence of desaturation

    Incidence of desaturation as defined by a decrease in oxygen saturation of greater than 3% from induction to lowest oxygen saturation within 2 minutes after completion of the airway management procedure.

    Measured: Induction to 2 minutes after completion of the airway management procedure

  5. Lowest oxygen saturation in the 24 hours after intubation.

    Measured: 24 hours after intubation

  6. Highest fraction of inspired oxygen in the 24 hours after intubation.

    Measured: 24 hours after intubation

  7. Highest positive end expiratory pressure in the 24 hours after intubation.

    Measured: 24 hours after intubation

  8. Lowest oxygen saturation, highest fraction of inspired oxygen, and highest positive end expiratory pressure from 0-1, 1-6, and 6- 24 hours after intubation.

    Lowest oxygen saturation, highest fraction of inspired oxygen, and highest positive end expiratory pressure from 0-1, 1-6, and 6- 24 hours after intubation.

    Measured: 24 hours after intubation

  9. Operator-reported pulmonary aspiration

    Visualization of oropharyngeal or gastric contents in the pharynx, larynx, or trachea between induction and completion of airway management.

    Measured: Induction to 2 minutes after completion of the airway management procedure

  10. New infiltrate on chest imaging in the 48 hours after intubation

    Determination of new infiltrate will be made by two blinded experts (pulmonary/critical care attendings or fellows) with adjudication by a third expert in the case of discordant results

    Measured: 48 hours after intubation

  11. Operator-reported pulmonary aspiration, new chest x-ray infiltrate, OR lowest oxygen saturation < 80% (composite outcome)

    Measured: 48 hours after intubation

  12. New pneumothorax or pneumomediastinum on chest imaging in the 24 hours after intubation

    Measured: 24 hours after intubation

  13. Incidence of esophageal intubation

    Measured: Induction to 2 minutes after completion of the airway management procedure

  14. Lowest systolic blood pressure (peri-procedural)

    Lowest systolic blood pressure between induction and two minutes after completion of the airway management procedure

    Measured: Induction to 2 minutes after completion of the airway management procedure

  15. New systolic blood pressure < 65 mmHg or new need for vasopressor

    New systolic blood pressure < 65 mmHg or new need for vasopressor between medication administration and 2 minutes following successful placement of an endotracheal tube

    Measured: Induction to 2 minutes after completion of the airway management procedure

  16. Cardiac arrest within one hour of intubation

    Measured: One hour after intubation.

  17. Death within one hour of intubation

    Measured: One hour after intubation

  18. Cormack-Lehane grade of glottic view

    Measured: Induction to 2 minutes after completion of the airway management procedure

  19. Operator-assessed difficulty of intubation

    Measured: Induction to 2 minutes after completion of the airway management procedure

  20. Incidence of successful intubation on the first laryngoscopy attempt

    Measured: Induction to 2 minutes after completion of the airway management procedure

  21. Number of laryngoscopy attempts

    Measured: Induction to 2 minutes after completion of the airway management procedure

  22. Time from induction to successful intubation

    Measured: Induction to 2 minutes after completion of the airway management procedure

  23. Need for additional airway equipment or a second operator

    Measured: Induction to 2 minutes after completion of the airway management procedure

  24. In-hospital mortality

    Measured: 28 days

  25. Ventilator-free days

    Ventilator-free days to day 28 will be defined as the number of days alive and with unassisted breathing to day 28 after enrollment, assuming a patient survives for at least two consecutive calendar days after initiating unassisted breathing and remains free of assisted breathing. If a patient returns to assisted breathing and subsequently achieves unassisted breathing prior to day 28, VFD will be counted from the end of the last period of assisted breathing to day 28. If the patient is receiving assisted ventilation at day 28 or dies prior to day 28, VFD will be 0. If a patient is discharged while receiving assisted ventilation, VFD will be 0. All data will be censored at the first of hospital discharge or 28 days.

    Measured: 28 days

  26. Intensive care unit-free days

    ICU-free days to 28 days after enrollment will be defined as the number of days alive and not admitted to an intensive care unit service after the patient's final discharge from the intensive care unit in that hospitalization before 28 days. Patients who are never discharged from the intensive care unit will receive a value of 0. Patients who die before day 28 will receive a value of 0. For patients who return to an ICU and are subsequently discharged prior to day 28, ICU-free days will be counted from the date of final ICU discharge. All data will be censored at the first of hospital discharge or 28 days.

    Measured: 28 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Jan 2017 (estimated)
  2. Study start15 Mar 2017
  3. Primary completion6 May 2018
  4. Study completion6 Jul 2018

Resources

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 N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
401 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03026322
Sponsor's protocol ID
IRB #161962
Acronym
PreVent
Status last verified
Sep 2018
First submitted
16 Jan 2017
Last updated
13 Sep 2018
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Casey JD, Janz DR, Russell DW, Vonderhaar DJ, Joffe AM, Dischert KM, Brown RM, Zouk AN, Gulati S, Heideman BE, Lester MG, Toporek AH, Bentov I, Self WH, Rice TW, Semler MW; PreVent Investigators and the Pragmatic Critical Care Research Group. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2019 Feb 28;380(9):811-821. doi: 10.1056/NEJMoa1812405. Epub 2019 Feb 18.

    PubMed 30779528
  • Casey JD, Janz DR, Russell DW, Vonderhaar DJ, Joffe AM, Dischert KM, Brown RM, Lester MG, Zouk AN, Gulati S, Stigler WS, Rice TW, Semler MW; PreVent Investigators and the Pragmatic Critical Care Research Group. Manual ventilation to prevent hypoxaemia during endotracheal intubation of critically ill adults: protocol and statistical analysis plan for a multicentre randomised trial. BMJ Open. 2018 Aug 10;8(8):e022139. doi: 10.1136/bmjopen-2018-022139.

    PubMed 30099400

Questions about this trial

What is this clinical trial studying?

A study testing Manual Ventilation and No Manual Ventilation in people with Respiratory Failure and Respiratory Failure With Hypoxia, run by Vanderbilt University Medical Center at 5 sites 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 5 inclusion and 4 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: finished, as of the sponsor's last update on 13 Sep 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites 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.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Lowest arterial oxygen saturation (time frame: Induction to 2 minutes after completion of the airway management procedure). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03026322, which also lists 2 linked publications.

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 13 Sep 2018.

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