AzTrials
AzTrials

Ventilator LungAVACNCT06157073

Efficacy and Safety of Automated Closed-loop Ventilator vs Conventional Open-loop Ventilator in the Emergency Department

A study testing Closed-loop ventilator and Open-loop ventilator in people with Ventilator Lung and Mechanical Ventilation Complication, run by University of Malaya.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Trial summary

Patients presenting to the emergency department (ED) may require breathing support with machines depending on the condition. Throughout the breathing support, the settings on the breathing machines will be tailored to the patient's requirements. These settings are manually adjusted by trained physicians. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Closed-loop ventilator and Open-loop ventilator
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
132 participants
Where
No sites listed yet
Study dates
1 Jan 2024to 31 Dec 2025
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

  • Decision made by treating physicians to intubate and mechanically ventilate

Who cannot join

  • Suspected or confirmed pregnancy.
  • Known right ventricular heart failure upon assessment for recruitment.
  • Severe metabolic acidosis upon intubation (pH <7.2 or bicarbonate <12 mmol/L)
  • Circulatory shock requiring noradrenaline more than 0.5 mcg/kg/min upon assessment for recruitment.
  • Severe or acute life-threatening asthma.
  • Patients with chest wall deformities that would affect ventilation (e.g. severe kyphoscoliosis, diaphragmatic hernia, flail chest, trauma, pectus excavatum or carinatum, ankylosing spondylitis
Show all 15Show fewer
  • Patients with previous lobectomy or pneumonectomy.
  • Patients with pneumothorax or other condition that requires chest drainage tube.
  • Patients with body mass index > 40 kg/m2.
  • Manufacturer's contraindications:
  • Difference in oxygen saturation between pulse oximetry (SpO2) and arterial sample (SaO2) of more than 5% (due to unreliable sensor).
  • Difference in carbon dioxide level between end-tidal sensor (ETCO2) and arterial sample (PaCO2) of more than 5 mm Hg (due to unreliable sensor).
  • Known pneumothorax and bronchopulmonary fistula upon assessment for recruitment.
  • Participation in another interventional trial.
  • Do-not-attempt-resuscitation (DNAR) order.

Trial locations and contacts

No sites are listed yet.

Dr Muhaimin, MMed contact

+60173600157

muhaimin@um.edu.my

About this study

Official title: A Randomized, Controlled Trial to Evaluate the Efficacy and Safety of Fully Automated Closed-loop Ventilator Versus Conventional Open-loop Ventilator in Ventilated Patients in the Emergency Department

Patients presenting to the emergency department (ED) may require breathing support with machines depending on the condition. Throughout the breathing support, the settings on the breathing machines will be tailored to the patient's requirements. These settings are manually adjusted by trained physicians. Currently, there are machines which can automatically change the settings based on real-time specific information obtained from the patient. This study aims to compare the use of machines which require manual adjustments (open-loop conventional ventilators) and machines which can automatically change the settings (closed-loop automated ventilators). Patients will be carefully selected to ensure no harm is caused whilst delivering the best care. This study will look into the duration when patients are receiving optimum settings and levels of oxygen and carbon dioxide in the blood. The outcomes of this study would allow us to identify methods to improve patient care.

Read the detailed description

Invasive mechanical ventilation is a lifesaving intervention for patients with respiratory failure in the emergency department (ED). Recent technological advancements have introduced closed-loop automated ventilators as a potential alternative to open-loop conventional ventilators. However, the efficacy and safety of closed-loop automated ventilators in the emergency setting remains understudied. This research aims to evaluate the efficacy and safety of closed-loop automated ventilator compared to open-loop conventional ventilator in intubated and ventilated patients in the ED.

A randomized controlled trial will be conducted in an ED of a tertiary university-affiliated hospital. Eligible patients are 18 years or older, decision made by treating physicians to intubate and mechanically ventilate. Some of exclusion criteria are pregnancy, heart failure, metabolic acidosis, circulatory shock, life-threatening asthma and morbid obesity. The primary measure of efficacy is the duration of ventilation within a predefined range of acceptable respiratory parameters between automated and conventional ventilation. Secondary outcome measures are; number of manual adjustments required to attain targeted settings in automated and conventional ventilators, PaO2/FiO2 ratio (PF ratio), arterial blood gas results, vital signs, breath-by-breath analysis, and rate of ventilator dyssynchrony. The ventilator used in the intervention arm is the closed-loop automated ventilator Hamilton C6s INTELLIVENT-ASV (Hamilton Medical AG, Switzerland). Hamilton C1 ASV is chosen as the open-loop conventional comparator as it is similar to Hamilton C6s INTELLIVENT-ASV, without the INTELLIVENT software.

Based on Lellouche et al, the calculated total sample size with a dropout rate of 10% is 132. The data is analysed based on the intention-to-treat (ITT) and per-protocol (PP) principles. The primary endpoint measurements are reported as areas under the curves (AUC) within the predefined range of acceptable respiratory parameters. Between-group differences in continuous variables are analysed using independent t-test or Mann-Whitney U test. Between-group differences in categorical variables are analysed using chi-square test.

Being tested
Closed-loop ventilator, Open-loop ventilator
Keywords
mechanical ventilation, closed loop ventilator, open loop ventilator, emergency department
Medical subject headings
Ventilator-Induced Lung Injury, Emergencies

What participants receive

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

  • Closed-loop ventilatorDevice

    Fully automated closed-loop ventilator using the INTELLIVENT software

  • Open-loop ventilatorDevice

    Conventional closed-loop ventilator with manual adjustments by the physician in charge

Study groups in NCT06157073
Study groupRoleWhat they receive
Open-loop ventilatorActive comparatorPrior to the rapid sequence intubation, patients' gender and height are set on the ventilator. The physician in-charge will setup the ventilator based on the lung condition, following the research protocol. Patients will be connected to this ventilator upon securing the airway. Ventilator setting parameters will be manually adjusted by the in-charge physician following local guidelines.
Receives: Device: Open-loop ventilator
Closed-loop ventilatorExperimentalPrior to the rapid sequence intubation, patients' gender and height are set on the ventilator. Patients' condition settings are selected depending on the lung condition. The sensors for end-tidal carbon dioxide (EtCO2) and oxygen saturation (SpO2) will be connected. Patients will be connected to this ventilator upon securing the airway. Ventilator setting parameters will be set following the study protocol.
Receives: Device: Closed-loop ventilator

What is being measured

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

  1. Duration of ventilation within a predefined range of acceptable respiratory parameters

    Duration of ventilation (in minutes) within predefined acceptable tidal volume (TV), plateau pressure, EtCO2 and SpO2

    Measured: Every 30 seconds for 240 minutes

Secondary outcomes (15)
  1. Manual adjustments of ventilator settings

    Frequency of manual adjustments of ventilator settings and the parameters requiring adjustments

    Measured: Any time the manual adjustment is performed throughout the 4-hour study period

  2. Physiological data - blood pressure

    Patient's blood pressure in mmHg

    Measured: Mean hourly for 4 hours

  3. Physiological data - respiratory rate

    Patient's respiratory rate in breaths per minute

    Measured: Mean hourly for 4 hours

  4. Physiological data - heart rate

    Patient's heart rate in beats per minute

    Measured: Mean hourly for 4 hours

  5. Biochemical data - pH

    Arterial pH levels

    Measured: Upon intubation, at 1-hour, 2-hour, 3-hour and 4-hour

  6. Biochemical data - CO2 and O2

    Arterial partial pressure of carbon dioxide and oxygen in mmHg

    Measured: Upon intubation, at 1-hour, 2-hour, 3-hour and 4-hour

  7. Biochemical data - bicarbonate

    Arterial bicarbonate levels in mmol/L

    Measured: Upon intubation, at 1-hour, 2-hour, 3-hour and 4-hour

  8. Patient outcome - mechanical ventilation

    Duration of mechanical ventilation

    Measured: Assessed from time of intubation to time of successful extubation or death from any cause, whichever came first, assessed up to 28 days

  9. Patient outcome - LOS ED

    Length of stay in emergency department

    Measured: Assessed from time of triage to time patient leaves ED or death, whichever comes first, up to 7 days

  10. Patient outcome - LOS ICU

    Length of intensive care unit stay

    Measured: Assessed from time of admission into the ICU to time of transfer to general ward or death, whichever comes first up to 28 days

  11. Patient outcome - LOS hospital

    Length of hospital stay

    Measured: Assessed from time of triage in ED to time of discharge or in-hospital death, whichever comes first up to 28 days

  12. Mortality rate

    Number and percentage of deaths

    Measured: At 14 and 28 days after recruitment

  13. Number of patients developing ARDS and pneumothorax

    Development of complications (pneumothorax, ARDS) during study and throughout admission

    Measured: At anytime within the 4-hour intervention or upon discharge or diagnosis of complications

  14. Ventilator data - airway pressures

    Ventilator parameters: mean and peak airway pressures in cmH20

    Measured: Every 30 seconds for 240 minutes

  15. Ventilator data - FiO2

    Ventilator parameters: fraction of inspired oxygen (FiO2)

    Measured: Every 30 seconds for 240 minutes

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 2023
  2. Study start1 Jan 2024 (estimated)
  3. Primary completion31 Dec 2024 (estimated)
  4. Study completion31 Dec 2025 (estimated)

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
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Model description
Subjects who meet all criteria for enrolment will be randomized in a 1:1 allocation ratio to receive either open-loop ventilator (OLV) or closed-loop ventilator (CLV). Randomization will be stratified by the respiratory pathology present: normal lung, hypercapnic respiratory failure and decreased lung compliance. Randomization sequence will be generated using a web-based randomisation software.
Masking
None (open label)
Enrolment
132 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06157073
Sponsor's protocol ID
2023317-12254
Other IDs
NMRR ID-23-03290-LRC
Acronym
AVAC
Status last verified
Nov 2023
First submitted
16 Nov 2023
Last updated
5 Dec 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data for this study will not be made publicly available. However, summary results and study outcomes will be transparently reported in the form of aggregated data and CSV files. This approach ensures that key findings are accessible while respecting participant confidentiality.

Publications

  • Lellouche F, Bouchard PA, Simard S, L'Her E, Wysocki M. Evaluation of fully automated ventilation: a randomized controlled study in post-cardiac surgery patients. Intensive Care Med. 2013 Mar;39(3):463-71. doi: 10.1007/s00134-012-2799-2. Epub 2013 Jan 22.

    PubMed 23338569
  • Savioli G, Ceresa IF, Gri N, Bavestrello Piccini G, Longhitano Y, Zanza C, Piccioni A, Esposito C, Ricevuti G, Bressan MA. Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions. J Pers Med. 2022 Feb 14;12(2):279. doi: 10.3390/jpm12020279.

    PubMed 35207769
  • Angotti LB, Richards JB, Fisher DF, Sankoff JD, Seigel TA, Al Ashry HS, Wilcox SR. Duration of Mechanical Ventilation in the Emergency Department. West J Emerg Med. 2017 Aug;18(5):972-979. doi: 10.5811/westjem.2017.5.34099. Epub 2017 Jul 11.

    PubMed 28874952
  • Arnal JM, Garnero A, Novonti D, Demory D, Ducros L, Berric A, Donati S, Corno G, Jaber S, Durand-Gasselin J. Feasibility study on full closed-loop control ventilation (IntelliVent-ASV) in ICU patients with acute respiratory failure: a prospective observational comparative study. Crit Care. 2013 Sep 11;17(5):R196. doi: 10.1186/cc12890.

    PubMed 24025234
  • Clavieras N, Wysocki M, Coisel Y, Galia F, Conseil M, Chanques G, Jung B, Arnal JM, Matecki S, Molinari N, Jaber S. Prospective randomized crossover study of a new closed-loop control system versus pressure support during weaning from mechanical ventilation. Anesthesiology. 2013 Sep;119(3):631-41. doi: 10.1097/ALN.0b013e3182952608.

    PubMed 23619172
  • Chelly J, Mazerand S, Jochmans S, Weyer CM, Pourcine F, Ellrodt O, Thieulot-Rolin N, Serbource-Goguel J, Sy O, Vong LVP, Monchi M. Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING). Crit Care. 2020 Jul 22;24(1):453. doi: 10.1186/s13054-020-03155-3.

    PubMed 32698860

Questions about this trial

What is this clinical trial studying?

A study testing Closed-loop ventilator and Open-loop ventilator in people with Ventilator Lung and Mechanical Ventilation Complication, run by University of Malaya.

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 1 inclusion and 15 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 5 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

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?

Contact Dr Muhaimin, MMed (+60173600157, muhaimin@um.edu.my), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Duration of ventilation within a predefined range of acceptable respiratory parameters (time frame: Every 30 seconds for 240 minutes). 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 NCT06157073, which also lists 6 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 5 Dec 2023.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in