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Hypoxemic Respiratory FailureNCT04971148

Correlation of Peak Tidal Inspiratory Flow Measured Before and After Extubation in Adult Patients With Hypoxemia

A study testing HFNC flow set at patient peak tidal inspiratory flow, HFNC flow set at 1.33 times of patient peak tidal inspiratory flow and HFNC flow set at 1.67 times of patient peak tidal inspiratory flow in people with Hypoxemic Respiratory Failure, run by Rush University Medical Center at 2 sites in 2 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

In this study, patients who are ready for extubation and indicated for high-flow nasal cannula therapy after extubation will be enrolled, the investigators would measure the patient peak tidal inspiratory flow (PTIF) pre and post extubation to explore the correlation between the two PTIFs. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
Hypoxemic Respiratory Failure
What is being tested?
HFNC flow set at patient peak tidal inspiratory flow, HFNC flow set at 1.33 times of patient peak tidal inspiratory flow and HFNC flow set at 1.67 times of patient peak tidal inspiratory flow
Could I receive a placebo?
No, everyone receives an active treatment
How many people
5 participants
Where
2 sitesin 2 countries
Study dates
7 Apr 2022to 8 Aug 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 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult intubated patients aged between 18 to 90 years
  • Pass spontaneous breathing trial and receive the order to be extubated
  • Have at least one of the indications to use HFNC after extubation

Who cannot join

  • Need to use inhaled epoprostenol via HFNC
  • Pregnant
  • Unable to use resuscitation mask, such as facial trauma, claustrophobia
  • Non-English speaker
  • Inability to verbally communicate
  • Using extracorporeal membrane oxygenation (ECMO)
  • Hemodynamically unstable
  • Difficult airway

Trial locations and contacts

2 sites in 2 countries.

2 sites in 2 countries

United States1 site
  • Rush university medical center

    Chicago, Illinois, 60612

Other trials in United States

Spain1 site
  • Hospital Universitari Vall d'Hebron

    Barcelona

Other trials in Spain

About this study

Official title: Correlation of Peak Tidal Inspiratory Flow Measured Before and After Extubation in Adult Patients With Hypoxemia, and Patients' Responses to Different Flows Above Their Peak Tidal Inspiratory Flow During High Flow Nasal Cannula Therapy

In this study, patients who are ready for extubation and indicated for high-flow nasal cannula therapy after extubation will be enrolled, the investigators would measure the patient peak tidal inspiratory flow (PTIF) pre and post extubation to explore the correlation between the two PTIFs. Moreover, different HFNC flows would be applied, to explore the patient response in terms of oxygenation and lung aeration to different flow ratios that matched and are above post-extubation PTIF.

Read the detailed description

High-flow nasal cannula (HFNC) oxygen therapy has been shown to improve oxygenation, reduce the need for intubation for patients with acute hypoxemic respiratory failure (AHRF) and avoid reintubation for post-extubation patients who had high-risk factors. HFNC refers to the delivery of gas at flows that exceed the patient peak inspiratory flow during tidal breathing, However, patient peak tidal inspiratory flow (PTIF) is found to vary greatly among different patients, from 20 to 50 L/min, making it difficult to properly set HFNC in a way to achieve the desired effects. In two recently published studies in intubated patients, PTIF varied from 25-65 L/min or 40-80 L/min, thus this study aims to investigate the correlation between pre-extubation PTIF in different modalities of SBT and post-extubation PTIF for adult patients, who are indicated to use HFNC immediately after extubation. In addition, the investigators aim to explore the patient response in terms of oxygenation and lung aeration to different flow ratios that matched and are above post-extubation PTIF.

Being tested
HFNC flow set at patient peak tidal inspiratory flow, HFNC flow set at 1.33 times of patient peak tidal inspiratory flow, HFNC flow set at 1.67 times of patient peak tidal inspiratory flow, HFNC flow set at 2 times of patient peak tidal inspiratory flow
Keywords
high-flow nasal cannula, flow setting, peak tidal inspiratory flow, hypoxemia
Medical subject headings
Respiratory Insufficiency, Hypoxia

What participants receive

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

  • HFNC flow set at patient peak tidal inspiratory flowOther

    HFNC flow will be set at the level equal to patient peak tidal inspiratory flow

  • HFNC flow set at 1.33 times of patient peak tidal inspiratory flowOther

    HFNC flow will be set at 1.33 times of patient peak tidal inspiratory flow

  • HFNC flow set at 1.67 times of patient peak tidal inspiratory flowOther

    HFNC flow will be set at 1.67 times of patient peak tidal inspiratory flow

  • HFNC flow set at 2 times of patient peak tidal inspiratory flowOther

    HFNC flow will be set 2 times of patient peak tidal inspiratory flow

Study groups in NCT04971148
Study groupRoleWhat they receive
HFNC flow set at patient peak tidal inspiratory flowActive comparatorHFNC flow will be set at the level that matches patient peak tidal inspiratory flow
Receives: Other: HFNC flow set at patient peak tidal inspiratory flow
HFNC flow set at 1.33 times of patient peak tidal inspiratory flowExperimentalHFNC flow will be set at the level that is 1.33 times of patient peak tidal inspiratory flow
Receives: Other: HFNC flow set at 1.33 times of patient peak tidal inspiratory flow
HFNC flow set at 1.67 times of patient peak tidal inspiratory flowExperimentalHFNC flow will be set at the level that is 1.67 times of patient peak tidal inspiratory flow
Receives: Other: HFNC flow set at 1.67 times of patient peak tidal inspiratory flow
HFNC flow set at 2 times of patient peak tidal inspiratory flowExperimentalHFNC flow will be set at the level that is 2 times of patient peak tidal inspiratory flow
Receives: Other: HFNC flow set at 2 times of patient peak tidal inspiratory flow

What is being measured

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

  1. SpO2/FIO2

    Twenty mins after each flow setting, pulse oximetry divided by fraction of inspired oxygen will be used to assess patient's oxygenation response to different flow

    Measured: 20 minutes after each flow setting

Secondary outcomes (2)
  1. End-expiratory lung volume assessed by EIT

    Twenty mins after each flow setting, electrical impedance tomography (EIT) will be used to assess patient's end -expiratory lung volume 20 mins after each flow setting

    Measured: 20 minutes after each flow setting

  2. self-evaluated comfort

    Twenty mins after each flow setting, patient comfort will be assessed using a visual numerical scale with a score of 0 as the worst and 10 as the best comfort

    Measured: 20 minutes after each flow setting

Timeline

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

  1. First posted21 Jul 2021
  2. Study start7 Apr 2022
  3. Primary completion8 Aug 2023
  4. Study completion8 Aug 2023

Why it stopped: Difficulty in recruiting patients

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
Randomised
Intervention model
Crossover
Model description
Patients will be randomized to receive different HFNC flow settings (matching their peak tidal inspiratory flow \[PTIF\], 1.33 times of PTIF, 1.67 times of PTIF and 2 times of PTIF)
Masking
None (open label)
Enrolment
5 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04971148
Sponsor's protocol ID
HFNC-Flow-004
Status last verified
Aug 2023
First submitted
12 Jul 2021
Last updated
14 Aug 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified patient data will be shared upon reasonable request 3 months after publication.

Publications

  • Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, Prat G, Boulain T, Morawiec E, Cottereau A, Devaquet J, Nseir S, Razazi K, Mira JP, Argaud L, Chakarian JC, Ricard JD, Wittebole X, Chevalier S, Herbland A, Fartoukh M, Constantin JM, Tonnelier JM, Pierrot M, Mathonnet A, Beduneau G, Deletage-Metreau C, Richard JC, Brochard L, Robert R; FLORALI Study Group; REVA Network. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015 Jun 4;372(23):2185-96. doi: 10.1056/NEJMoa1503326. Epub 2015 May 17.

    PubMed 25981908
  • Rochwerg B, Granton D, Wang DX, Helviz Y, Einav S, Frat JP, Mekontso-Dessap A, Schreiber A, Azoulay E, Mercat A, Demoule A, Lemiale V, Pesenti A, Riviello ED, Mauri T, Mancebo J, Brochard L, Burns K. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019 May;45(5):563-572. doi: 10.1007/s00134-019-05590-5. Epub 2019 Mar 19.

    PubMed 30888444
  • Hernandez G, Vaquero C, Colinas L, Cuena R, Gonzalez P, Canabal A, Sanchez S, Rodriguez ML, Villasclaras A, Fernandez R. Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial. JAMA. 2016 Oct 18;316(15):1565-1574. doi: 10.1001/jama.2016.14194.

    PubMed 27706464
  • Hernandez G, Vaquero C, Gonzalez P, Subira C, Frutos-Vivar F, Rialp G, Laborda C, Colinas L, Cuena R, Fernandez R. Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial. JAMA. 2016 Apr 5;315(13):1354-61. doi: 10.1001/jama.2016.2711.

    PubMed 26975498
  • Yasuda H, Okano H, Mayumi T, Narita C, Onodera Y, Nakane M, Shime N. Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis. Crit Care. 2021 Apr 9;25(1):135. doi: 10.1186/s13054-021-03550-4.

    PubMed 33836812
  • Butt S, Pistidda L, Floris L, Liperi C, Vasques F, Glover G, Barrett NA, Sanderson B, Grasso S, Shankar-Hari M, Camporotaa L. Initial setting of high-flow nasal oxygen post extubation based on mean inspiratory flow during a spontaneous breathing trial. J Crit Care. 2021 Jun;63:40-44. doi: 10.1016/j.jcrc.2020.12.022. Epub 2020 Dec 27.

    PubMed 33621890
  • Mauri T, Spinelli E, Dalla Corte F, Scotti E, Turrini C, Lazzeri M, Alban L, Albanese M, Tortolani D, Wang YM, Spadaro S, Zhou JX, Pesenti A, Grasselli G. Noninvasive assessment of airflows by electrical impedance tomography in intubated hypoxemic patients: an exploratory study. Ann Intensive Care. 2019 Jul 22;9(1):83. doi: 10.1186/s13613-019-0560-5.

    PubMed 31332551
  • Mauri T, Alban L, Turrini C, Cambiaghi B, Carlesso E, Taccone P, Bottino N, Lissoni A, Spadaro S, Volta CA, Gattinoni L, Pesenti A, Grasselli G. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med. 2017 Oct;43(10):1453-1463. doi: 10.1007/s00134-017-4890-1. Epub 2017 Jul 31.

    PubMed 28762180
  • Li J, Jing G, Scott JB. Year in Review 2019: High-Flow Nasal Cannula Oxygen Therapy for Adult Subjects. Respir Care. 2020 Apr;65(4):545-557. doi: 10.4187/respcare.07663.

    PubMed 32213602
  • Li J, Scott JB, Fink JB, Reed B, Roca O, Dhand R. Optimizing high-flow nasal cannula flow settings in adult hypoxemic patients based on peak inspiratory flow during tidal breathing. Ann Intensive Care. 2021 Nov 27;11(1):164. doi: 10.1186/s13613-021-00949-8.

    PubMed 34837553

Questions about this trial

What is this clinical trial studying?

A study testing HFNC flow set at patient peak tidal inspiratory flow, HFNC flow set at 1.33 times of patient peak tidal inspiratory flow and HFNC flow set at 1.67 times of patient peak tidal inspiratory flow in people with Hypoxemic Respiratory Failure, run by Rush University Medical Center at 2 sites in 2 countries.

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 8 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: stopped early, as of the sponsor's last update on 14 Aug 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States, Spain. 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 was stopped early (reason given: Difficulty in recruiting patients). 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?

SpO2/FIO2 (time frame: 20 minutes after each flow setting). 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 NCT04971148, which also lists 10 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 14 Aug 2023.

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