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Motor Neuron DiseaseVOTECO2ALSNCT03764384

Validation Of Tidal/End -Tidal CO2 in ALS

An observational study of Motor Neuron Disease and Amyotrophic Lateral Sclerosis, run by Papworth Hospital NHS Foundation Trust at 1 site in United Kingdom.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The study team propose that a new, hand-held test device may be valuable in the management of breathing failure in patients with Motor Neurone Disease (MND). The study team need to validate this device against the current gold standard of blood gas analysis and determine whether people with MND can use it at home. Read more about this study

Who is it for?
Ages 18 years and older
How many people
200 participants
Where
1 siteUnited Kingdom
Study dates
20 Aug 2018to 4 Jun 2021
Phase
Observational
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

Study population: Participants will have previously been diagnosed with Motor Neurone Disease by a neurologist. Study participants will be recruited from patients attending weekly Motor Neurone Disease clinics within the RSSC at Royal Papworth Hospital.

Who may be able to join

  • 1. Male or female with a diagnosis of definite or probable Motor Neurone Disease according to El Escorial criteria.
  • 2. Willing and able to provide informed consent.

Who cannot join

  • Lung, chest wall, neuromuscular, cardiac or other comorbidity or abnormality that would markedly affect spirometry and/or other measures of lung function or TBCO2 measurements. To be judged by the CI.
  • Tracheostomy in situ
  • Additional Eligibility Criteria for Home Monitoring patients Patients invited to use the N-Tidal CTM data collecting device within the study would be selected using the following additional inclusion criteria. These patients in theory would be most likely to get reliable results from the capnometer, be candidates for NIV, and to reach one of the study end-points within the follow-up period.
  • Home monitoring Inclusion Criteria:
  • Not in ventilatory failure at the start of the study (PaCO2 < 6.0 KPa)
  • Sufficient manual dexterity and arm strength to use the device (or have a live-in carer/spouse/family member able to assist and willing to do so).
Show all 11Show fewer
  • Verified able to use the device (by trial with dummy device).
  • Stated intention at the start of the study that they will accept NIV if they develop ventilatory failure.
  • Home Monitoring Exclusion Criteria
  • In the opinion of the clinical investigator, the participant would have difficulty completing the study procedures consistently.
  • Established on NIV treatment

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Royal Papworth NHS Foundation Trust

    Papworth Everard, Cambridge, CB23 3RE

Other trials in United Kingdom

About this study

Official title: An Observational Study in People With Amyotrophic Lateral Sclerosis to Validate Tidal /End-Tidal CO2, Measured by the N-Tidal C™ Against Directly Measured PaCO2 and to Determine the Ease of Home Use of the Device

The study team propose that a new, hand-held test device may be valuable in the management of breathing failure in patients with Motor Neurone Disease (MND). The study team need to validate this device against the current gold standard of blood gas analysis and determine whether people with MND can use it at home. The new device, called 'N-Tidal C™' measures the carbon dioxide (CO2) in expired breath. At the end of the breath (end tidal) the CO2 level gives an indication of the CO2 in the person's arterial blood. Ventilatory failure is diagnosed at present using the value of CO2 in the arterial blood, but usually this can only be measured in specialist clinics. The study will determine if the end tidal CO2 measured by the new device agrees with CO2 measured on a blood test in clinic and also whether or not the device is practical for home use. The team will analyse the output of the device during home monitoring to see if changes in the pattern of CO2 in the expired breath identify, or even predict, the development of breathing failure in the community. With the results of these measures and detailed information about the patients in Papworth's clinic, recruited to this study, collected over a year the team will design a follow on study to see if using the new device at home can improve survival and quality of life for people with MND.

Read the detailed description

This is a prospective, observational study of patients attending Royal Papworth Hospital's weekly MND clinic. If a patient decides to participate in the study, they will continue to receive all normal care. Researchers will ask permission to review the results of any medical investigations and tests previously undertaken, by looking in medical records and will collect new data prospectively. There will be two groups of patients recruited:

A).Hospital Questionnaire Monitoring Group (12 months) for up to 200 patients who will:

  1. Have four routine hospital based assessments (every 3 months, standard care) ii) Above usual care: completion of the ALSFRS-R questionnaire at each clinic (4 in total. The ALSFRS-R (Amyotrophic Lateral Sclerosis Functional Rating Score-Revised) measures range of difficulties that people with MND can have in their daily lives. The results from this questionnaire help to measure the severity of MND symptoms, and how fast the disease is progressing. B). Home Device Monitoring Group (12-24 months) for 30 patients These participants patient will be given a portable monitoring device (called the N-Tidal C) to record their breathing pattern in clinic and at home and have: i) Four to six routine hospital based assessments (every 3 months, standard care). At the discretion of the investigator this may be at each clinic visit up to a total of 24 months ii) Completion of an ALSFRS-R symptom questionnaire at each visit (4-6 in total). At the discretion of the investigator this may be at each clinic visit up to a total of 24 months iii) Telephone consultation 2 weeks after commencing home monitoring to validate correct and safe use of the device (1 in total) iv) Completion of a supervised N-Tidal C breath record at each clinic visit (4 to 6 total). At the discretion of the investigator this may be at each clinic visit up to a total of 24 months v) Completion of a weekly symptom diary (up to 52 in total). At the discretion of the investigator this may continue up to 24 months vi) Home monitoring with N-Tidal C for 75 seconds, up to 3 times per day (up to study finish). SA 02 introduced an additional modified breath holding manoeuvre for home monitoring patients in clinic.

The range of 4 to 6 assessments covers the eventuality that participants may start in group A and transfer to group B as their condition changes. This will be determined by the treating doctor and will be based upon their lung function, limb weakness and whether they (or a carer) are able to use the device. During the home monitoring trial, data collected by the N-Tidal C device will be downloaded at each clinic visit, to check that the device is correctly recording data. Researchers will not be able to analyse the data collected by the device.

Only the information obtained from the standard measurements (standard care) will be used to decide when a patient needs help with their breathing at night time by starting a ventilator. A patient participating in the Home Monitoring Group will continue to use their N-Tidal C device to record their daytime breathing up to 3 times per day, after they start using a ventilator.

Keywords
PaCO2, N-Tidal C Device, Self-monitoring, CO2 waveforms
Medical subject headings
Motor Neuron Disease, Amyotrophic Lateral Sclerosis

What participants receive

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

Study groups in NCT03764384
Study groupRoleWhat they receive
Hospital Monitoring Group - ALSFRS-R cohortAll patients will be first recruited to this cohort unless at their first visit the investigator deems them eligible for the Home Monitoring Device Group. At the initial screening visit, all patients recruited into the study will undergo routine assessments according to the existing MND protocol, and additionally complete the ALSFRS-R symptom-based assessment questionnaire by interview with the study researchers (with assistance from spouse, family member or carer if required). Patients will continue to complete the ALSFRS-R symptom-based questionnaire at each clinic attendance.
Home Monitoring CohortIf eligible patients will use the N Tidal CTM, up to 3 times a day (morning, midday and evening) throughout the home monitoring period until the final outpatient clinic visit. In addition subjects will complete a weekly diary symptom monitoring diary which asks them about their respiratory symptoms, GP attendances, respiratory infections. Patients routine standard of care assessments will also be documented according to the protocol as well as completing the ALSFRS-R at each visit.

What is being measured

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

  1. The primary outcome of interest is the degree of agreement between end tidal CO2 measured by the N-Tidal CTM device and PaCO2 from arterial blood gas analysis.

    Arterial blood gas (measured in kPa) will be compared to the end tidal CO2 (kPa) measured from the N-Tidal CTM device. The measurements will be taken within 20 minutes of each other. The paired CO2 measures from N-Tidal CTM device and from ABG will be assessed for agreement. The results will be displayed graphically using a Bland Altman Plot and the mean difference, the standard deviation of the mean difference and confidence intervals for 95% limits of agreement will be reported.

    Measured: At each clinic visit through to study completion up to 24 months

Secondary outcomes (2)
  1. Identify when an MND patient requires additional support with their breathing, in the form of starting NIV as derived from the CO2 measurement (kPA) and Respiratory Rate (RR) per minute from the N-Tidal CTM device.

    The waveforms taken from the N-Tidal CTM device will be analysed to give an end tidal CO2 (kPa) value and the mean and standard deviation of Respiratory rate per minute. Assuming there is an acceptable level of agreement between the two methods of measuring CO2 the data will be reviewed to establish if the end tidal measurement identified the onset of ventilatory failure before the clinic visit where it was confirmed on an arterial blood gas. After inspection of the data a judgement will be made on whether the correct measure is an individual result >6kPa or whether 2 or more consecutive measures >6 kPa would be the most reliable measure to conclude that ventilatory failure has now developed. For those participants who develop a PaCO2 > 6 kPa, the amount of time by which this predates the confirmatory blood gas will be reported in weeks.

    Measured: At each clinic visit through to study completion up to 24 months

  2. Identify when an MND patient develops a treatable respiratory condition, such as an infection as derived from the CO2 measurement (kPA) and Respiratory Rate (RR) per minute from the N-Tidal CTM device..

    The mean end tidal CO2 (kPa) and the mean RR taken from the N-Tidal CTM device on the day before and the day of an identified respiratory event (from the symptom diary) will be examined to see if there is a reproducible change in the signal that might indicate that a respiratory event has occurred assuming in the future that the device will be monitored remotely.

    Measured: At each clinic visit through to study completion up to 24 months

Timeline

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

  1. First posted5 Dec 2018
  2. Study start20 Aug 2018
  3. Primary completion4 Jun 2021 (estimated)
  4. Study completion4 Jun 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case crossover
Time perspective
Prospective
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03764384
Sponsor's protocol ID
P02366
Acronym
VOTECO2ALS
Status last verified
Mar 2021
First submitted
29 Aug 2018
Last updated
10 Mar 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bourke SC, Tomlinson M, Williams TL, Bullock RE, Shaw PJ, Gibson GJ. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurol. 2006 Feb;5(2):140-7. doi: 10.1016/S1474-4422(05)70326-4.

    PubMed 16426990
  • COPD clinical trial : NIHRCRN 19599, ISRCTN 56492264

  • O'Neill CL, Williams TL, Peel ET, McDermott CJ, Shaw PJ, Gibson GJ, Bourke SC. Non-invasive ventilation in motor neuron disease: an update of current UK practice. J Neurol Neurosurg Psychiatry. 2012 Apr;83(4):371-6. doi: 10.1136/jnnp-2011-300480. Epub 2011 Aug 17.

    PubMed 21849339
  • Checketts MR, Alladi R, Ferguson K, Gemmell L, Handy JM, Klein AA, Love NJ, Misra U, Morris C, Nathanson MH, Rodney GE, Verma R, Pandit JJ; Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016 Jan;71(1):85-93. doi: 10.1111/anae.13316. Epub 2015 Nov 19.

    PubMed 26582586
  • Banerjee SK, Davies M, Sharples L, Smith I. The role of facemask spirometry in motor neuron disease. Thorax. 2013 Apr;68(4):385-6. doi: 10.1136/thoraxjnl-2012-201804. Epub 2012 Jul 27. No abstract available.

    PubMed 22843559

Questions about this trial

What is this clinical trial studying?

An observational study of Motor Neuron Disease and Amyotrophic Lateral Sclerosis, run by Papworth Hospital NHS Foundation Trust at 1 site in United Kingdom.

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 2 inclusion and 11 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: status not confirmed, as of the sponsor's last update on 10 Mar 2021. 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 Kingdom. 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?

Results are not available in the source record.

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?

The primary outcome of interest is the degree of agreement between end tidal CO2 measured by the N-Tidal CTM device and PaCO2 from arterial blood gas analysis. (time frame: At each clinic visit through to study completion up to 24 months). 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 NCT03764384, which also lists 5 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 10 Mar 2021.

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