Morbid ObesityNCT02297828
Effect of Boussignac CPAP Ventilation on PaO2 and PaO2/FiO2 Ratio in Morbidly Obese Patients Undergoing Bariatric Surgery
A study testing Boussignac CPAP and Venturi face mask in people with Morbid Obesity, run by Centro Hospitalar do Porto at 1 site in Portugal.
Trial summary
The purpose of this study is to determine if the application of Boussignac continuous positive airway pressure (CPAP) immediately after extubation improves PaO2 and PaO2/FiO2 ratio in morbidly obese patients undergoing gastric bypass surgery . Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Morbid Obesity
- What is being tested?
- Boussignac CPAP and Venturi face mask
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 24 participants
- Where
- 1 sitePortugal
- Study dates
- Oct 2014to Dec 2014
- 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 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients age between 18 and 65 years of age
- Morbidly obese with a body mass index > 35 kg/m2
- Laparoscopic gastric bypass
Who cannot join
- Patient refusal
- American Society of Anesthesiologists' (ASA) class IV
- Lung parenchyma disease
- Chronic Obstructive Pulmonary Disease
- Moderate to severe asthma
- Pre-existing cardiac failure (above class II in the New York Heart Association (NYHA) classification)
Show all 12Show fewer
- Estimated pulmonary artery pressure ≥35mmHg
- Hemoglobin concentration ([Hgb]) less than 7 g / dL
- Need for invasive ventilation during preoperative immediate post-extubation defined in the preoperative period
- Patients with obstructive sleep apnea previously treated with CPAP
- Severe psychiatric disorder
- Language barrier
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Effect of Boussignac Continuous Positive Airway Pressure Ventilation on PaO2 and PaO2/FiO2 Ratio Immediately After Extubation in Morbidly Obese Patients Undergoing Bariatric Surgery: a Randomized Controlled Trial
The purpose of this study is to determine if the application of Boussignac continuous positive airway pressure (CPAP) immediately after extubation improves PaO2 and PaO2/FiO2 ratio in morbidly obese patients undergoing gastric bypass surgery .
Read the detailed description
Background: In 2010, the prevalence of obesity in individuals above 15 years old in Portugal was 15.5% for males and 17.7% for females. .In this country bariatric surgery has increased significantly playing an important role in the treatment of individuals with BMI ≥ 40 kg/m2 or less than 35 kg/m2 in the presence of comorbidities.
Morbid obesity has a negative impact in the respiratory physiology and is associated with a decreased compliance of the lung and chest wall, increased airway resistance, decreased respiratory muscle strength, increased work of breathing, worsening of ventilation / perfusion ratio and postoperative hypoxemia. General anesthesia and surgery in these patients will maximize these physiologic alterations.
Ahmad et al. (2008) found that morbid obesity per se, regardless of the presence of obstructive sleep apnea was associated with increased risk of desaturation in the first 24h of the postoperative period.
Gaszynski et al. (2007) found that the use of Boussignac CPAP in the postoperative period of patients undergoing bariatric surgery improved oxygenation. However, it was used capillary blood gas analysis not arterial blood and the FiO2 was different between groups.
More recently, in 2011, Wong et al. investigated the effect of Boussignac CPAP versus Venturi mask in the first one hour after bariatric surgery, measuring the PaO2 / FiO2 ratio at 1 hour and 2 hours of the postoperative period. The group maintained with CPAP showed better results. There were no differences between the two groups for FEV1 and FVC. The study does not reveal, however, the analgesic protocol used postoperatively or the patient's position during the spirometric measurements. These variables could be possible confounders. The PaO2 absolute value was not evaluated because of the different FiO2 between patients.
Objectives: We aim to assess the impact of the application of Boussignac CPAP ventilation immediately after extubation for improving PaO2 and PaO2/FiO2 ratio in morbidly obese patients submitted to gastric bypass surgery. As a secondary objective we intend to evaluate if there are differences in spirometry parameters.
Methods: A randomized controlled study on 24 patients undergoing gastric bypass surgery. Control group receives a Ventury mask immediately after extubation and the intervention group gets the Boussignac CPAP immediately after extubation. Both groups have the same anesthetic protocol during the intraoperative period and receive a 50% FiO2 after extubation. Venturi mask and Boussignac CPAP are maintained for two hours. A blood sample is collected from radial artery to measure PaO2 and calculate PaO2/FiO2 ratio before surgery and at 1, 2 and 24 hours after extubation in both groups. Evaluation of forced expiraroty volume in 1 second (FEV1) and forced vital capacity (FVC) with a portable spirometer is also performed at the same intervals. Patients are monitored for oxygen saturation, arterial pressure and cardiac rhythm while using the devices. Tolerance to the device, analgesic requirements and sedation level are also monitored and registered.
- Conditions
- Morbid Obesity
- Being tested
- Boussignac CPAP, Venturi face mask
- Medical subject headings
- Obesity, Morbid
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Boussignac CPAPDevice
Boussignac CPAP with a 50% FiO2 (adjusted in a piece adapted to the system) and a pressure of 5cmH2O (measured with a manometer) is applied immediately after extubation and mantained for two hours after extubation in the post anesthesia care unit (PACU).
Venturi face maskDevice
Venturi mask with a 50% FiO2 is used immediately after extubation and mantained for two hours in the post anesthesia care unit (PACU).
| Study group | Role | What they receive |
|---|---|---|
| Boussignac CPAP | Experimental | Boussignac CPAP with a 50% FiO2 (adjusted in a piece adapted to the system) and a pressure of 5cmH2O (measured with a manometer) is applied immediately after extubation and mantained for two hours after extubation in the post anesthesia care unit (PACU).
Arterial blood samples to measure PaO2 and PaO2/FiO2 ratio are collected before surgery and at 1, 2 and 24 hours after extubation. Spirometry is performed at the same intervals measuring FEV1 and FVC. Receives: Device: Boussignac CPAP |
| Ventury face mask | Active comparator | Venturi mask with a 50% FiO2 is used immediately after extubation and mantained for two hours in the post anesthesia care unit (PACU).
Arterial blood samples to measure PaO2 and PaO2/FiO2 ratio are collected before surgery and at 1, 2 and 24 hours after extubation. Spirometry is performed at the same intervals measuring FEV1 and FVC. Receives: Device: Venturi face mask |
What is being measured
The primary outcome is the main question the study is designed to answer.
Difference in mean PaO2 values after surgery
Arterial blood samples for blood gas analysis are collected at 1 hour, 2 hours and 24 hours post-extubation. The differences in the mean values of PaO2 are registered and analysed.
Measured: 24 hours
Difference in mean PaO2/FiO2 ratio values after surgery
Arterial blood samples for blood gas analysis are collected at 1 hour, 2 hours and 24 hours post-extubation. The differences in the mean values of PaO2/FiO2 ratio are registered and analysed.
Measured: 24 hours
Secondary outcomes (1)
Difference in mean FEV 1 and FVC values
Spirometry is performed at 1 hour, 2 hours and 24 hours post-extubation. The differences in the mean values of FEV1 and FVC are measured and analysed.
Measured: 24 hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Nov 2014 (estimated)
- Study startOct 2014
- Primary completionNov 2014
- Study completionDec 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Morbid ObesityStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 24 participants (actual)
Sponsor and investigators
- Lead sponsor
- Centro Hospitalar do Porto
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Joana Alexandra Carvalho Guimarães, Centro Hospitalar do Porto
- Investigators
- Joana Guimarães, MD, Principal investigator, Centro Hospitalar do Porto
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02297828
- Sponsor's protocol ID
- 278/13
- Status last verified
- Apr 2015
- First submitted
- 17 Nov 2014
- Last updated
- 24 Apr 2015
- Results posted
- No
- Data monitoring committee
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 24 Apr 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Boussignac Continuous Positive Airway Pressure Ventilation on PaO2 and PaO2/FiO2 Ratio Immediately After Extubation in Morbidly Obese Patients Undergoing Bariatric Surgery: a Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT02297828
- Acronym / sponsor ID
- 278/13
- Conditions
- Morbid Obesity
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 24 participants (actual)
- Lead sponsor
- Centro Hospitalar do PortoUniversity, hospital or other
- Study start
- Oct 2014
- Primary completion
- Nov 2014 (actual)
- Study completion
- Dec 2014 (actual)
- First posted
- 21 Nov 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to determine if the application of Boussignac continuous positive airway pressure (CPAP) immediately after extubation improves PaO2 and PaO2/FiO2 ratio in morbidly obese patients undergoing gastric bypass surgery .
Detailed description
Background: In 2010, the prevalence of obesity in individuals above 15 years old in Portugal was 15.5% for males and 17.7% for females. .In this country bariatric surgery has increased significantly playing an important role in the treatment of individuals with BMI ≥ 40 kg/m2 or less than 35 kg/m2 in the presence of comorbidities.
Morbid obesity has a negative impact in the respiratory physiology and is associated with a decreased compliance of the lung and chest wall, increased airway resistance, decreased respiratory muscle strength, increased work of breathing, worsening of ventilation / perfusion ratio and postoperative hypoxemia. General anesthesia and surgery in these patients will maximize these physiologic alterations.
Ahmad et al. (2008) found that morbid obesity per se, regardless of the presence of obstructive sleep apnea was associated with increased risk of desaturation in the first 24h of the postoperative period.
Gaszynski et al. (2007) found that the use of Boussignac CPAP in the postoperative period of patients undergoing bariatric surgery improved oxygenation. However, it was used capillary blood gas analysis not arterial blood and the FiO2 was different between groups.
More recently, in 2011, Wong et al. investigated the effect of Boussignac CPAP versus Venturi mask in the first one hour after bariatric surgery, measuring the PaO2 / FiO2 ratio at 1 hour and 2 hours of the postoperative period. The group maintained with CPAP showed better results. There were no differences between the two groups for FEV1 and FVC. The study does not reveal, however, the analgesic protocol used postoperatively or the patient's position during the spirometric measurements. These variables could be possible confounders. The PaO2 absolute value was not evaluated because of the different FiO2 between patients.
Objectives: We aim to assess the impact of the application of Boussignac CPAP ventilation immediately after extubation for improving PaO2 and PaO2/FiO2 ratio in morbidly obese patients submitted to gastric bypass surgery. As a secondary objective we intend to evaluate if there are differences in spirometry parameters.
Methods: A randomized controlled study on 24 patients undergoing gastric bypass surgery. Control group receives a Ventury mask immediately after extubation and the intervention group gets the Boussignac CPAP immediately after extubation. Both groups have the same anesthetic protocol during the intraoperative period and receive a 50% FiO2 after extubation. Venturi mask and Boussignac CPAP are maintained for two hours. A blood sample is collected from radial artery to measure PaO2 and calculate PaO2/FiO2 ratio before surgery and at 1, 2 and 24 hours after extubation in both groups. Evaluation of forced expiraroty volume in 1 second (FEV1) and forced vital capacity (FVC) with a portable spirometer is also performed at the same intervals. Patients are monitored for oxygen saturation, arterial pressure and cardiac rhythm while using the devices. Tolerance to the device, analgesic requirements and sedation level are also monitored and registered.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Boussignac CPAP | Experimental | Device: Boussignac CPAPBoussignac CPAP with a 50% FiO2 (adjusted in a piece adapted to the system) and a pressure of 5cmH2O (measured with a manometer) is applied immediately after extubation and mantained for two hours after extubation in the post anesthesia care unit (PACU). Arterial blood samples to measure PaO2 and PaO2/FiO2 ratio are collected before surgery and at 1, 2 and 24 hours after extubation. Spirometry is performed at the same intervals measuring FEV1 and FVC. |
| Ventury face mask | Active comparator | Device: Venturi face maskVenturi mask with a 50% FiO2 is used immediately after extubation and mantained for two hours in the post anesthesia care unit (PACU). Arterial blood samples to measure PaO2 and PaO2/FiO2 ratio are collected before surgery and at 1, 2 and 24 hours after extubation. Spirometry is performed at the same intervals measuring FEV1 and FVC. |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Patients age between 18 and 65 years of age
- Morbidly obese with a body mass index > 35 kg/m2
- Laparoscopic gastric bypass
Key exclusion criteria (12 listed)
- Patient refusal
- American Society of Anesthesiologists' (ASA) class IV
- Lung parenchyma disease
- Chronic Obstructive Pulmonary Disease
- Moderate to severe asthma
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Boussignac CPAPBoussignac CPAP with a 50% FiO2 (adjusted in a piece adapted to the system) and a pressure of 5cmH2O (measured with a manometer) is applied immediately after extubation and mantained for two hours after extubation in the post anesthesia care unit (PACU). | Device | Boussignac CPAP |
| Venturi face maskVenturi mask with a 50% FiO2 is used immediately after extubation and mantained for two hours in the post anesthesia care unit (PACU). | Device | Ventury face mask |
Primary outcome
Difference in mean PaO2 values after surgery
Time frame: 24 hours
Arterial blood samples for blood gas analysis are collected at 1 hour, 2 hours and 24 hours post-extubation. The differences in the mean values of PaO2 are registered and analysed.
Difference in mean PaO2/FiO2 ratio values after surgery
Time frame: 24 hours
Arterial blood samples for blood gas analysis are collected at 1 hour, 2 hours and 24 hours post-extubation. The differences in the mean values of PaO2/FiO2 ratio are registered and analysed.
1 secondary outcome
Difference in mean FEV 1 and FVC values
Time frame: 24 hours
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Apr 2015.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Joana Guimarães, MD principal investigator
Centro Hospitalar do Porto
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Boussignac CPAP and Venturi face mask in people with Morbid Obesity, run by Centro Hospitalar do Porto at 1 site in Portugal.
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 24 Apr 2015. 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 Portugal. 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?
Difference in mean PaO2 values after surgery (time frame: 24 hours). The study lists 2 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 24 Apr 2015.