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ICU PatientsTriggerNCT04041817

Pulmonary and Ventilatory Effects of Trigger Modulation in Intubated ICU

A study testing Trigger setting of pressure support ventilation in people with ICU Patients and Intubation, run by University Hospital, Clermont-Ferrand at 1 site in France.

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

Pressure support ventilation allows intubated ICU patients to breathe spontaneously. Among specific settings, the adjustment of the trigger value (or threshold for triggering the ventilator) has not been explored to date. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
ICU Patients, Intubation, Spontaneously Breathing
What is being tested?
Trigger setting of pressure support ventilation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
30 participants
Where
1 siteFrance
Study dates
3 Apr 2019to 31 Jan 2023
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

  • Age ≥18 years
  • Patient hospitalized in the Intensive Care Unit of Clermont-Ferrand's Hospital
  • Patients with mechanical invasive ventilation in spontaneous ventilation with inspiratory support (intubation or tracheostomy)
  • Trigger level set to minimum
  • Patient under sedation compatible with spontaneous ventilation (SV) with inspiratory support (AI) and positive end-expiratory pressure (PEP) Patient calm (RASS between -2 and 0) Consent for participation or consent from patient's next of kin or inclusion according to an emergency procedure Patient benefiting from the French social security scheme

Who cannot join

  • Refusal to participate in the proposed study
  • Contraindication to the installation of a nasogastric tube:
  • Severe disorder of uncorrected blood clotting
  • Known nasosinus lesion
  • Oesophageal varices recently ligated (<48h)
  • Contraindication to the use of the electro-impedancemetry technique by tomography
Show all 17Show fewer
  • Thoracic lesions
  • Chest dressings
  • Pace-maker / Implantable Defibrillator
  • Known lesion of central respiratory centers, including patients with neurological injury
  • Patients with Acute Respiratory Distress Syndrome (according to Berlin criteria)
  • Patients with restrictive or obstructive pulmonary pathology
  • Patients admitted post-operatively for surgery that may affect the diaphragmatic function ( thoracic or abdominal supra-mesocolic)
  • Patients with abdominal distention (ileus, intra-abdominal hyperpressure)
  • Patient whose BMI is greater than 35 kg.m-2
  • Pregnant patient
  • Patient under guardianship,

Trial locations and contacts

1 site in 1 country.

France1 site
  • Service de Réanimation Adultes et Soins Continus

    Clermont-Ferrand, 63000

Other trials in France

About this study

Official title: Pulmonary and Ventilatory Effects of Trigger Modulation in Intubated ICU Patients Spontaneously Breathing With Pressure Support Ventilation. A Physiopathology Exploratory Study.

Pressure support ventilation allows intubated ICU patients to breathe spontaneously. Among specific settings, the adjustment of the trigger value (or threshold for triggering the ventilator) has not been explored to date. The trigger threshold corresponds to the sensitivity of the ventilator to detect patient's inspiratory effort and then deliver the predefined pressure support to inflate the lungs and deliver a tidal volume. The purpose of this study is to explore the influence of trigger level on pulmonary and ventilatory physio (-patho)logical parameters in spontaneously breathing ICU patients.

Read the detailed description

The use of invasive mechanical ventilation is one of the most frequent therapies in intensive care units (ICUs). There are several types of indications, depending on the failure: essentially neurological, hemodynamic or respiratory.

In recent years, the notion of lung damage induced by mechanical ventilation (VILI) has led to major changes in ventilator settings in both ICUs and operative rooms (Ors). The reduction of the tidal volume (TV) to 6-8 mL/kg of ideal body weight, the use of an individualized positive end-of-expiratory pressure (PEEP) and the possible use of pulmonary aeration optimization therapies (alveolar recruitment manoeuvres, prone positioning sessions...) have become essential to increase patient's survival.

Withdrawal of invasive mechanical ventilation remains a daily issue and traditionally requires the transition from fully controlled ventilation to pressure support ventilation. Among specific settings of the latter, the adjustment of the trigger value (or threshold for triggering the ventilator) has not been explored to date. The trigger threshold corresponds to the sensitivity of the ventilator to detect patient's inspiratory effort and then deliver the predefined pressure support to inflate the lungs and deliver a tidal volume. The lower (or more sensitive) the trigger threshold, the smallest patient's effort will be rewarded. On the other hand, the higher the threshold, the greater the inspiratory effort required from the patient. Usually, this value is set by default to the minimum level to avoid self-triggering of the ventilator. With the objective to optimize pulmonary aeration, the use of higher trigger levels could increase diaphragmatic work (with a potential re-training and reinforcement effect) and contribute to better alveolar recruitment in the postero-inferior territories that are traditionally the most impacted, following a higher diaphragmatic motion. The authors propose to explore the impact of different trigger levels on pulmonary aeration (evaluated by electrical impedance tomography) and ventilatory parameters, in order to validate our hypotheses and before considering a trial with the objective of defining individualized trigger levels, according to patient's respiratory mechanics and pulmonary parenchyma morphology, with potential benefits on ventilator weaning.

Being tested
Trigger setting of pressure support ventilation
Keywords
ICU, Pressure support ventilation, Spontaneous breathing, Trigger, Weaning of mechanical ventilation

What participants receive

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

  • Trigger setting of pressure support ventilationOther

    Trigger variations will be performed following increasing steps of 3 L/min every 15 minutes, from 0.2 to 15 L/min (0.2 - 3 - 6 - 9 - 12 - 15).

Study groups in NCT04041817
Study groupRoleWhat they receive
Trigger increasing stepsExperimentalTrigger variations will be performed following increasing steps of 2 L/min every 15 minutes. End expiratory lung volume and lung aeration will be conducted using elecrical impedance tomography. Diaphragmatic motion and thickening will be analyzed by ultrasonography. Work of breathing will be evaluated using gastric and oesophageal pressure measurements. Measurements will be conducted during the last minute of each step.
Receives: Other: Trigger setting of pressure support ventilation

What is being measured

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

  1. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T0 (before the first trigger step)

  2. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T15 minutes (last minute of the trigger step n°1)

  3. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T30 minutes (last minute of the trigger step n°2)

  4. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T45 minutes (last minute of the trigger step n°3)

  5. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T60 minutes (last minute of the trigger step n°4)

  6. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T75 minutes (last minute of the trigger step n°5)

  7. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T90 minutes (last minute of the trigger step n°6)

  8. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T105 minutes (last minute of the trigger step n°7)

  9. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T120 minutes (last minute of the trigger step n°8)

  10. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T135 minutes (last minute of the trigger step n°9)

  11. Lung volume (end expiratory lung volume, EELV) at each trigger level

    The main endpoint is the difference between the lung volume (EELV) measured by electroimpedancemetry by tomography (EIT) at the end of each trigger level (15th minute) and the basal value measured at the beginning of the protocol

    Measured: T150 minutes (last minute of the trigger step n°10)

Secondary outcomes (14)
  1. Homogeneity of pulmonary aeration

    Evaluation of homogeneity of pulmonary aeration with Center Of Ventilation by EIT

    Measured: Through study completion, 150 minutes

  2. Homogeneity of pulmonary aeration

    Evaluation of homogeneity of pulmonary aeration with Global Inhomogeneity index by EIT

    Measured: Through study completion, 150 minutes

  3. Regional impedance variation

    Evaluation of regional impedance variation (TIV: Tidal Impedance Variation) by EIT

    Measured: Through study completion, 150 minutes

  4. Atelectrauma

    Assessement of atelectrauma (RVD: Regional Ventilation Delay) by EIT

    Measured: Through study completion, 150 minutes

  5. Lung volume variations

    Evaluation of lung volume variations by EIT (EELI : End Expiratory Lung Impedance)

    Measured: Through study completion, 150 minutes

  6. Transpulmonary pressure

    Evaluation of maximum transpulmonary pressure (alveolar stress)

    Measured: Through study completion, 150 minutes

  7. Alveolar strain defined as the ratio between tidal volume and Functional Residual Capacity

    Alveolar strain defined as the ratio between tidal volume and Functional Residual Capacity

    Measured: Through study completion, 150 minutes

  8. Transpulmonary driving pressure

    Evaluation of transpulmonary driving pressure

    Measured: Through study completion, 150 minutes

  9. Work of breathing

    Evaluation of work of breathing (WOB) value (P01)

    Measured: Through study completion, 150 minutes

  10. Work of breathing

    Evaluation of inspiratory occlusion pressure values (P01)

    Measured: Through study completion, 150 minutes

  11. Energy delivered

    Evaluation of energy delivered to lungs patient

    Measured: Measurement during the last minute of each trigger step

  12. Diaphragm thickening

    Evaluation of the diaphragmatic thickening by ultrasound

    Measured: Through study completion, 150 minutes

  13. Diaphragm motion

    Evaluation of the diaphragmatic motion by ultrasound

    Measured: Through study completion, 150 minutes

  14. Patient's weight

    Study of the impact of patient's weight

    Measured: Through study completion, 150 minutes

Timeline

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

  1. First posted1 Aug 2019
  2. Study start3 Apr 2019
  3. Primary completion31 Jan 2023
  4. Study completion31 Jan 2023

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
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
30 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04041817
Sponsor's protocol ID
Trigger - RBHP 2018 GODET
Other IDs
2018-A03307-48
Acronym
Trigger
Status last verified
Feb 2023
First submitted
25 Jul 2019
Last updated
17 Feb 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Trigger setting of pressure support ventilation in people with ICU Patients and Intubation, run by University Hospital, Clermont-Ferrand at 1 site in France.

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 17 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 17 Feb 2023. 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 France. 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?

Lung volume (end expiratory lung volume, EELV) at each trigger level (time frame: T0 (before the first trigger step)). The study lists 11 primary outcomes in all. 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 17 Feb 2023.

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