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Respiratory Distress Syndrome, AdultPhase 2NCT00351533

A Phase II Randomized Trial of Fish Oil in Patients With Acute Lung Injury (ALI)

A Phase 2 study testing Fish oil (eicosapentaenoic acid and docosahexanoic acid) in people with Respiratory Distress Syndrome, Adult and Acute Lung Injury, run by University of Washington at 5 sites in 2 countries.

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

The purpose of this study is to determine whether fish oil (containing omega-3 fatty acids) given enterally is safe and effective in reducing lung and systemic inflammation seen in acute lung injury. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Fish oil (eicosapentaenoic acid and docosahexanoic acid)
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
90 participants
Where
5 sitesin 2 countries
Study dates
Jul 2006to Aug 2009
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

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

  • Requiring positive-pressure mechanical ventilation
  • ALI criteria: PaO2/FiO2 <300, bilateral infiltrates on chest radiograph, no left atrial hypertension
  • Age > 17 years

Who cannot join

  • Expected ICU length of stay <48 hours
  • Unable to undergo bronchoalveolar lavage at enrollment
  • Unable to obtain enteral access
  • Post-cardiac arrest with suspected significant anoxic brain injury
  • Expected survival < 28 days
  • Pregnant
Show all 12Show fewer
  • Platelet count < 30,000, active bleeding, or international normalized ratio (INR)>3.0
  • History of ventricular tachycardia or fibrillation
  • Receiving recombinant human activated protein C (rh-APC) for sepsis
  • Acquired immune deficiency syndrome (AIDS) with CD4 count < 200
  • Metastatic cancer
  • History of bone marrow, lung, liver, cardiac, kidney, or pancreas transplant

Trial locations and contacts

5 sites in 2 countries.

5 sites in 2 countries

United States4 sites
  • St. Alphonsus Medical Center

    Boise, Idaho, 83706

  • University of Vermont/Fletcher Allen Health Care

    Burlington, Vermont, 05401

  • Oregon Health Sciences University

    Portland, Oregon, 97239

  • Harborview Medical Center

    Seattle, Washington, 98104

Other trials in United States

Canada1 site
  • St. Michael's Hospital

    Toronto, Ontario, M5B1W8

Other trials in Canada

About this study

Official title: A Randomized, Double-blind Study of the Effect of Fish Oil (Eicosapentaenoic Acid and Docosahexanoic Acid) on Lung and Systemic Inflammation in Patients With Acute Lung Injury (ALI)

The purpose of this study is to determine whether fish oil (containing omega-3 fatty acids) given enterally is safe and effective in reducing lung and systemic inflammation seen in acute lung injury.

Read the detailed description

Acute lung injury (ALI) is common among critically ill patients and is associated with a high case fatality. Only one intervention has been shown to improve survival in a large clinical trial, and new therapies targeting the inflammatory response are needed. Nutrient interventions may provide benefit; specifically there is plausible biologic rationale for administering n-3 fatty acids (n-3 FAs) found in fish oil to patients with ALI, as n-3 FAs decrease formation of eicosanoid inflammatory mediators. However, although promising results have emerged from prior studies, fish oils have only been tested in ALI patients in a commercial enteral formula containing additional nutrients, and the control group received a high-fat enteral formula that may have been proinflammatory. Therefore, no conclusion can be drawn about the independent effect of fish oils. Furthermore, the inclusion of key pharmaconutrients in feeding formulas, instead of delivering them separately as pharmaceuticals, limits exposure to the agent, as intensive care unit (ICU) patients commonly receive less than 60% of prescribed caloric needs. Finally, specialized feeding formulas are very expensive, and it may be substantially cheaper to administer pharmaconutrients separately. We believe it is time to begin to approach nutrient trials in critically ill patients differently -- to move away from including them in feeding formulas and begin delivering them like pharmaceuticals. With appropriate scientific investigation and the use of non-nutrient placebos, this novel and innovative approach is a new paradigm of investigating nutrient delivery to critically ill patients.

This study is a phase II randomized controlled trial to determine the effects of enteral eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), both n-3 FAs found in fish oil, versus placebo on the pulmonary and systemic environments, and on clinical outcomes, in patients with ALI. We will investigate the effect of fish oil administration on several biological markers of injury and inflammation in bronchoalveolar lavage fluid and serum, on pulmonary physiologic outcomes, and on clinical outcomes.

Comparison(s): Mechanically ventilated patients with acute lung injury randomized to receive enteral fish oil versus compared to mechanically ventilated patients with acute lung injury randomized to receive placebo.

Being tested
Fish oil (eicosapentaenoic acid and docosahexanoic acid)
Keywords
Respiratory distress syndrome, adult, Acute lung injury, Acute respiratory distress syndrome, ARDS, human, Fish oils, Fatty Acids, Omega-3, Docosahexaenoic Acids, Eicosapentaenoic Acid
Medical subject headings
Respiratory Distress Syndrome, Acute Lung Injury

What participants receive

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

  • Fish oil (eicosapentaenoic acid and docosahexanoic acid)Drug

    Liquid fish oil 7.5cc enterally every 6 hours

Study groups in NCT00351533
Study groupRoleWhat they receive
1ExperimentalEnteral fish oil
Receives: Drug: Fish oil (eicosapentaenoic acid and docosahexanoic acid)
2Placebo comparatorEnteral saline
Receives: Drug: Fish oil (eicosapentaenoic acid and docosahexanoic acid)

What is being measured

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

  1. Change in Bronchoalveolar Lavage Fluid (BALF) Interleukin (IL)-8

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent the 2nd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

Secondary outcomes (27)
  1. Change in BALF Leukotriene B4

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent the 2nd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  2. Change in BALF Interleukin-6

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent the 2nd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  3. Change in BALF Monocyte Chemotactic Protein-1

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent the 2nd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  4. Change in BALF Neutrophil Count

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent the 2nd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  5. Static Lung Compliance

    30 patients in the fish oil group and 36 patients in the enteral saline group remained intubated on day 5 and had this outcome available.

    Measured: Day 5

  6. Oxygenation

    PaO2/FiO2 is the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen. 30 patients in the fish oil group and 36 patients in the enteral saline group remained intubated on day 5 and had this outcome available.

    Measured: Day 5

  7. Change in Plasma Interleukin-8

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent 2nd blood draw on day 5. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  8. Change in Plasma Leukotriene B4

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent 2nd blood draw on day 5. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  9. Change in Plasma Interleukin-6

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent 2nd blood draw on day 5. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  10. Change in Plasma Surfactant Protein D

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent 2nd blood draw on day 5. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  11. Change in Plasma vonWillebrand Factor

    30 patients in the fish oil group and 36 patients in the enteral saline group underwent 2nd blood draw on day 5. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 5

  12. Worst Multiple Organ Dysfunction Score (MODS) During First 28 Days After Study Enrollment

    Full scale name is Multiple Organ Dysfunction Score (MODS), a scale measuring degree of organ dysfunction in critically ill patients.

    Minimum score is 0 and maximum score is 24, with 0 indicating no organ failure and 24 indicating severe failure of multiple organs.

    Measured: Throughout hospital stay

  13. Ventilator-free Days During First 28 Days After Study Enrollment

    Ventilator-free days is a common outcome measure in critical care research. A ventilator-free day is a day that a participant is alive and not receiving mechanical ventilation during the first 28 days after s/he enrolled in the study.

    Measured: 28 days

  14. ICU-free Days During First 28 Days After Study Enrollment

    ICU-free days is a common outcome measure in critical care research. An ICU-free day is a day that a participant is alive and not in the intensive care unit (ICU) during the first 28 days after s/he enrolled in the study.

    Measured: 28 days

  15. Hospital Length of Stay

    Measured: At end of hospital admission

  16. Hospital Mortality

    Measured: At end of hospitalization

  17. 60-day Mortality

    Measured: 60 days from day of enrollment into study

  18. Change in Bronchoalveolar Lavage Fluid (BALF) Interleukin (IL)-8

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent the 3rd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  19. Change in BALF Leukotriene B4

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent the 3rd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  20. Change in BALF Interleukin-6

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent the 3rd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  21. Change in BALF Monocyte Chemotactic Protein-1

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent the 3rd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  22. Change in BALF Neutrophil Count

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent the 3rd bronchoalveolar lavage (BAL). Participants did not undergo BALs after baseline if they were not intubated or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  23. Change in Plasma Interleukin-8

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent 3rd blood draw on day 9. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  24. Change in Plasma Leukotriene B4

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent 3rd blood draw on day 9. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  25. Change in Plasma Interleukin-6

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent 3rd blood draw on day 9. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  26. Change in Plasma Surfactant Protein D

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent 3rd blood draw on day 9. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

  27. Change in Plasma vonWillebrand Factor

    15 patients in the fish oil group and 27 patients in the enteral saline group underwent 3rd blood draw on day 9. Participants did not undergo blood draws after baseline if they were discharged from the ICU or had expired, but clinical followup data (e.g. mortality) were collected.

    Measured: Days 1 and 9

Timeline

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

  1. First posted13 Jul 2006 (estimated)
  2. Study startJul 2006
  3. Primary completionJan 2009
  4. Study completionAug 2009

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
90 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00351533
Sponsor's protocol ID
28503-A
Other IDs
05-7895-A 03
Status last verified
Aug 2011
First submitted
11 Jul 2006
Last updated
3 Oct 2011
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Fish oil (eicosapentaenoic acid and docosahexanoic acid) in people with Respiratory Distress Syndrome, Adult and Acute Lung Injury, run by University of Washington at 5 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 12 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 3 Oct 2011. 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, Canada. 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 3 Oct 2011). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Change in Bronchoalveolar Lavage Fluid (BALF) Interleukin (IL)-8 (time frame: Days 1 and 5). 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 3 Oct 2011.

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