AtelectasisNCT02892773
Comparing the Effectiveness of Lung Expansion Therapy in Adult Human Subjects
A study testing Incentive Spirometry and EzPAP® Positive Airway Pressure in people with Atelectasis, run by University of Virginia at 1 site in United States.
Trial summary
The purpose of this study is to better understand how air is spread throughout study participants' lungs after abdominal surgery by comparing two lung inflation treatments: 1. Incentive Spirometry (I.S.) lung expansion therapy 2. EzPAP® lung expansion therapy. Read more about this study
- Who is it for?
- Ages 18 to 79 years
- Conditions the study is for
- Atelectasis
- What is being tested?
- Incentive Spirometry and EzPAP® Positive Airway Pressure
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 112 participants
- Where
- 1 siteUnited States
- Study dates
- Jan 2017to 12 Nov 2018
- 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 79 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Human subjects 18 - 79 years of age
- Post-operative upper abdominal surgery
- Examples:
- Laparotomy
- Biliodigestive anastomosis
- Cholecystectomy
Show all 16Show fewer
- Enterectomy
- Esophagectomy
- Gastrectomy
- Hepatectomy
- Pancreatectomy
- Unassisted spontaneous breathing
- Attending surgeon's approval
- Anticipated post-operative hospital length of stay greater than 3 days
- Documentation of written informed consent
- Ability to sign consent
Who cannot join
- Less than 18 or greater than 79 years of age
- Anticipated post-operative hospital length of stay less than 3 days
- Body mass index > 50
- Excessive chest hair
- Inability to obtain written informed consent
- Inability to follow verbal instructions
Show all 19Show fewer
- Pregnancy-self reported
- uncontrolled body movements
- Insertion of an artificial airway
- Hemodynamic instability
- Loss of skin integrity at site where EIT electrodes and belt are projected to come into contact (i.e., chest burns, open wounds/lesions, etc…).
- Chest tube or dressings that prohibit placement of EIT electrodes and belt
- Active implants (i.e., cardiac pacemaker, implantable cardioverter-defibrillator [ICD]), diaphragm pacer, or when device compatibility is in doubt.)
- Invasive or non-invasive mechanical ventilation support
- Unstable spinal lesions or fractures
- Untreated pneumothorax
- Active hemoptysis
- Esophageal surgery
- Decision to withhold life-sustaining treatment
Trial locations and contacts
1 site in 1 country.
United States1 site
University of Virginia Medical Center
Charlottesville, Virginia, 22903
About this study
Official title: A Randomized Controlled Trial Comparing the Effectiveness of Lung Expansion Therapy Following Upper Abdominal Surgery in Adult Human Subjects
The purpose of this study is to better understand how air is spread throughout study participants' lungs after abdominal surgery by comparing two lung inflation treatments:
- Incentive Spirometry (I.S.) lung expansion therapy
- EzPAP® lung expansion therapy.
Read more
Lung expansion therapy is routinely used after upper abdominal surgery. Taking deep breaths after surgery helps lungs to stay inflated. At the University of Virginia, it is at the physician's discretion as to which treatment will be used to help with deep breathing lung inflation therapy after surgery. The investigators would like to know which of the lung inflation therapies is better at helping inflate participants' lungs.
The investigators will be using a device called Electrical Impedance Tomography (EIT) to measure how effectively air spreads in participants' lungs. This device is not currently approved by the Food and Drug Administration (FDA) for the purpose used in this study, and therefore, it is considered investigational.
Investigators are inviting eligible participants to consider participating in this study because doctors order Incentive Spirometry as a standard of care following upper abdominal surgery. Information gained from monitoring how air is spread throughout participants' lungs will help investigators to determine if there is a clinical difference and benefit when comparing Incentive Spirometry and EzPAP lung expansion therapies.
Read the detailed description
Investigators will use a convenience sampling scheme to identify potential study participants. Documentation of informed consent will be recorded. Electrical Impedance Tomography (EIT), which provides non-invasive and radiation free monitoring, will be used to monitor and measure regional distribution of ventilation during Incentive Spirometry (I.S.) and EzPAP® lung expansion therapy. The PulmoVista 500 EIT device has a reported high patient safety profile and poses minimal patient risk.
The potential benefit for study participants will not be realized directly since the investigators' aim is to only monitor regional distribution of ventilation in response to I.S. or EzPAP® lung expansion therapy. While I.S. is considered to be a standard of post-operative care, there is low quality evidence documenting I.S. effectiveness in preventing pulmonary complications after upper abdominal surgery.
Loss of dorsal lung volume (i.e., atelectasis) is an example of a post-operative pulmonary complication. EzPAP® is a lung expansion therapy that is used as an alternative to I.S. lung expansion therapy for increasing dorsal regional lung volume (i.e., Functional Residual Volume [FRC]) in an effort to prevent or reverse atelectasis. When expiratory positive airway pressures of 5, 10, and 15 cmH2O was administered to a small group of healthy human subjects, medical researchers identified that a positive pressure of 15 cmH2O was associated with the greatest FRC increase when compared to zero pressure and baseline FRC measurements.
While study participants may not benefit directly from this study, investigators anticipate that important information will be gained from EIT monitoring of regional distribution of ventilation. Future upper abdominal post-operative surgical patients may benefit from this study's findings as investigators hope to advance clinical understanding associated with these therapies with use of EIT.
Procedure set-up and device calibration will occur according to Draeger provided PulmoVista 500 EIT training and operation manual instructions:
- Study participant preparation
- Investigators will assess the participant's thorax to ensure that the skin's surface is free of body fluids that may prevent or impede electrode contact. Skin surface will be wiped clean with a dry cloth if necessary.
- Investigators will select an electrode belt and respective patient cable sizes after measuring participant's chest circumference with paper measurement tape placed across the midclavicular line at intercostal space 4 -5. Electrode belt size will be selected according to chest circumference measurement.
- A patient cable of the same electrode belt size will be selected and connected to the electrode belt before connection to participant. Investigators will align and snap connect the patient cable snaps over the electrode belt studs by aligning respective snaps and studs in ascending numerical order from 1 to 16 .
- A light spray of water may be applied to the black electrode surface on the electrode belt before it is applied to participant if natural moisture from the skin does not result in sufficient conductivity between the skin and electrodes.
- Investigators will attach an electrode belt and reference electrode to participant while they are lying supine in bed. Participant's head of bed will be positioned at 45-degrees.
- The electrode belt/cable combination will be attached around the thorax of each participant at the level of the 4th - 5th intercostal space, unless mammary tissue prevents this site of application. An alternative application site will be located immediately below the mammary tissue if necessary. Left to right belt orientation will be maintained with color coded patient cable ports signifying left and right side.
- Investigators will snap the electrode belt closed after verifying proper belt position. The belt's black electrodes should have close contact with the study participant's skin at this point.
- An adhesive ECG electrode will be place on the study participant's right upper abdominal quadrant and then the patient cable reference electrode snap will be attached to the ECG electrode.
- The patient cable will then be connected to the EIT monitoring device via a color coded trunk cable orientation that aligns with the patient cable left and right orientation
- EIT device calibration and signal check
- Investigators will initiate a PulmonVista 500 EIT monitoring device calibration each day prior to performing new study participant end-expiratory lung impedance measurements.
- A skin-electrode signal check will be performed to ensure that a minimum of 15 of 16 electrodes have sufficient contact with the participant's skin surface and signal quality is stable. Investigators will use the following status display and explanation to determine adequacy of electrode contact and signal quality.
- Monitoring sessions and Lung Expansion Therapy procedure
- Monitoring will be initiated after investigators perform PulmoVista 500 EIT device setup and calibration prior to one of the three scheduled lung expansion therapy sessions on day 1, 3, and 5 (if not discharged from hospital) after surgery.
- Approximate monitoring/measurement duration is 15-minutes.
- Lung expansion therapies will occur as follows:
- Participants will be positioned supine in bed or bedside chair with head of bed or bedside chair positioned at 45-degrees.
Incentive Spirometry Procedure Group:
- A respiratory therapist will provide instruction on Incentive Spirometry procedure performance before supervised therapy and monitoring begins.
- Participants will be asked to take 10 deep breaths through the incentive spirometer's mouthpiece, followed by a 60 second pause.
- The 10-breath cycle will be repeated three times with respiratory therapist coaching.
- Each Incentive Spirometry therapy session will last about 15 minutes three times per day.
- EIT monitoring and deep breathing measurements will occur during one of the three scheduled Incentive Spirometry sessions on day 1, 3, and 5 (if not discharged from hospital) after surgery.
EzPAP® Positive Airway Pressure Group:
- A respiratory therapist will provide instruction on EzPAP® procedure performance before supervised therapy and monitoring begins.
- Participants will be asked to breathe normally through the EzPAP® device's mouthpiece for 10 breaths, followed by a 60 second pause.
- The 10-breath cycle will be repeated three times with respiratory therapist coaching.
- Each TID EzPAP® therapy sessions will last about 15 minutes three times per day.
- EIT monitoring and deep breathing measurements will occur during one of the three scheduled Incentive Spirometry sessions on day 1, 3, and 5 (if not discharged from hospital) after surgery.
- PulmoVista set-up and monitoring sessions will be coordinated in collaboration with each participant's bedside nurse and a respiratory therapist. Initial setup and monitoring commitment time is approximately 15 - 20 minutes.
- Electrical Impedance Tomography lung monitoring and measurements will occur during one of three scheduled EzPAP® therapies on day 1, 3, and 5 (if not discharged from hospital) after surgery. Participants will continue to receive respective lung expansion therapy as ordered three times per day, but without EIT monitoring.
- Regional distribution of ventilation information will be displayed on the PulmoVista 500 device's main monitoring screen during lung expansion therapy. Clinical staff administering therapy and participants will be blinded from information displayed on the screen's monitor in an effort to reduce performance bias.
- Once lung expansion therapy session has ended, investigators will detach trunk cables from electrode cables, detach reference electrode snap from adhesive ECG electrode, unclamp the electrode belt, and then remove belt from the participant.
- Investigators will inspect the electrode belt contact area to assess for evidence of skin irritation or bruising. Participant's physician will be notified of any significant findings.
- Displaying changes
- Once the PulmoVista 500 EIT device is removed from participant's room, the investigator will change from main screen view to Display change view. Regional distribution of ventilation information displayed on the PulmoVista 500 EIT device's screen will be used to record pre and post lung expansion therapy end-expiratory lung impedance changes.
- PulmoVista 500 EIT device will be removed participant's room and returned to a storage location outside of patient care areas.
- Following each EIT to participant interface disconnect, an alcohol, aldehyde, or quaternary ammonium based compound will be soaked on a wipe cloth to disinfect the surfaces of the patient cable, electrode belt, trunk cable, and EIT unit.
- Participant's head of bed will be returned to original position or to an elevation that is preferred by the participant after therapy and monitoring session is complete.
- Participant will continue with assigned lung expansion therapy as scheduled.
- Conditions
- Atelectasis
- Being tested
- Incentive Spirometry, EzPAP® Positive Airway Pressure
- Keywords
- electrical impedance tomography, incentive spirometry, EzPAP, lung volume, atelectasis, positive airway pressure, pulmonary complication, abdominal surgery, end-expiratory lung volume
- Medical subject headings
- Pulmonary Atelectasis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Incentive SpirometryDevice
A respiratory therapist will provide instruction on Incentive Spirometry (I.S.) procedure performance before supervised therapy and monitoring begins.
- Study participants will be asked to take 10 deep breaths through the I.S.'s mouthpiece, followed by a 60 second pause.
- The 10-breath cycle will be repeated 3 times per therapy session.
- Each I.S. therapy session will last about 15 minutes, 3 times per day.
- Lung monitoring and deep breathing measurements will occur during a scheduled I.S. sessions on day 1, 3, and 5 after surgery.
EzPAP® Positive Airway PressureDevice
A respiratory therapist will provide instruction on EzPAP® procedure performance before supervised therapy and monitoring begins.
- Study participants will be asked to breathe normally through the EzPAP® device's mouthpiece for 10 breaths, followed by a 60 second pause.
- The 10-breath cycle will be repeated 3 times.
- Each EzPAP® therapy sessions will last about 15 minutes, 3 times per day.
- Lung monitoring will occur during a scheduled EzPAP® sessions on day 1, 3, and 5 after surgery.
| Study group | Role | What they receive |
|---|---|---|
| Incentive Spirometry Group | Other | * Participant will be asked to take 10 deep breaths through the mouthpiece of an incentive spirometer, followed by a 60 second pause.
* This cycle will be repeated two more times.
* A Respiratory Therapist will coach participants three times per day.
* Each duration of Incentive Spirometry will last about 15 minutes. Receives: Device: Incentive Spirometry |
| EzPAP® Positive Airway Pressure Group | Active comparator | * Participant will be coached by a Respiratory Therapist to breathe through the mouthpiece of an EzPAP® device for 10 breaths, followed by a 60 second pause.
* This cycle will be repeated two more times.
* The Respiratory Therapist will coach participants three times per day.
* Each duration of EzPAP® therapy will last about 15 minutes. Receives: Device: EzPAP® Positive Airway Pressure |
What is being measured
The primary outcome is the main question the study is designed to answer.
Ventral and Dorsal end-expiratory lung impedance redistribution of ventilation
EIT will be used to measure ventral and dorsal change in end-expiratory lung impedance before and after lung expansion therapy. Ventral and Dorsal lung impedance measurement is displayed on the EIT device as a percent (zero to 100). Investigators will record values into an electronic code book before and after lung expansion therapy. The difference between measured values will be used to quantify ventral and dorsal redistribution of ventilation.
- Statistical analysis
- An independent samples t-test or Mann-Whitney U test will be applied to determine if a statistically significant mean difference exists between groups.
- Data will be reported as mean (SD) and 95% CI or median (IQR) depending upon normality of distribution.
- Effect size = r (small effect </= 0.1; medium effect = 0.3; Large effect >/= 0.5
- Alpha set at ≤ 0.05 (two-tailed)
Measured: Two years
Secondary outcomes (1)
Incidences of post-operative pulmonary complications
Investigators will search participant's electronic medical record for documentation of atelectasis, hypoxemia, pneumonia, and acute respiratory failure. Data will be recorded in an electronic code book and total count for respective pulmonary complications will be used to quantify incidence of respective pulmonary complications.
- Statistical analysis
- Chi square for independence or Fisher's Exact Probability test will be applied to test for statistical significance.
- Respective post-operative complication will be reported as frequency (n)
- Relative Risk and Odds Ratio will be reported for effect size.
- Alpha set at ≤ 0.05 (two-tailed)
Measured: Two years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Sep 2016 (estimated)
- Study startJan 2017
- Primary completion12 Nov 2018
- Study completion12 Nov 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (12)Papers the sponsor has linked to this study.
- Other trials for AtelectasisStudies of the same condition, open and under way.
- More trials run by University of VirginiaThe sponsor's other registered studies.
- 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
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Care provider
- Enrolment
- 112 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Virginia
- Sponsor type
- University, hospital or other
- Collaborators
- Draeger Medical, Inc
- Responsible party
- Principal investigator, Daniel D Rowley, University of Virginia
- Investigators
- Daniel D Rowley, MSc RRT-ACCS, Principal investigator, Pulmonary Diagnostics & Respiratory Therapy Services, University of Virginia Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02892773
- Sponsor's protocol ID
- 19029
- Status last verified
- Nov 2018
- First submitted
- 28 Aug 2016
- Last updated
- 19 Nov 2018
- Results posted
- No
- Data monitoring committee
- No
- Individual data sharing
- Yes: Intend to submit overall study findings to peer reviewed medical journal after study completion.
Publications
do Nascimento Junior P, Modolo NS, Andrade S, Guimaraes MM, Braz LG, El Dib R. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev. 2014 Feb 8;2014(2):CD006058. doi: 10.1002/14651858.CD006058.pub3.
PubMed 24510642Fagevik Olsen M, Wennberg E, Johnsson E, Josefson K, Lonroth H, Lundell L. Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques. Br J Surg. 2002 Oct;89(10):1228-34. doi: 10.1046/j.1365-2168.2002.02207.x.
PubMed 12296888Garrard CS, Shah M. The effects of expiratory positive airway pressure on functional residual capacity in normal subjects. Crit Care Med. 1978 Sep-Oct;6(5):320-2. doi: 10.1097/00003246-197809000-00004.
PubMed 363357Hinz J, Neumann P, Dudykevych T, Andersson LG, Wrigge H, Burchardi H, Hedenstierna G. Regional ventilation by electrical impedance tomography: a comparison with ventilation scintigraphy in pigs. Chest. 2003 Jul;124(1):314-22. doi: 10.1378/chest.124.1.314.
PubMed 12853539Karsten J, Stueber T, Voigt N, Teschner E, Heinze H. Influence of different electrode belt positions on electrical impedance tomography imaging of regional ventilation: a prospective observational study. Crit Care. 2016 Jan 8;20:3. doi: 10.1186/s13054-015-1161-9.
PubMed 26743570Lunardi AC, Paisani DM, Silva CCBMD, Cano DP, Tanaka C, Carvalho CRF. Comparison of lung expansion techniques on thoracoabdominal mechanics and incidence of pulmonary complications after upper abdominal surgery: a randomized and controlled trial. Chest. 2015 Oct;148(4):1003-1010. doi: 10.1378/chest.14-2696.
PubMed 25973670Meier T, Luepschen H, Karsten J, Leibecke T, Grossherr M, Gehring H, Leonhardt S. Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography. Intensive Care Med. 2008 Mar;34(3):543-50. doi: 10.1007/s00134-007-0786-9. Epub 2007 Jul 25.
PubMed 17653529Parke RL, Bloch A, McGuinness SP. Effect of Very-High-Flow Nasal Therapy on Airway Pressure and End-Expiratory Lung Impedance in Healthy Volunteers. Respir Care. 2015 Oct;60(10):1397-403. doi: 10.4187/respcare.04028. Epub 2015 Sep 1.
PubMed 26329355Riedel T, Richards T, Schibler A. The value of electrical impedance tomography in assessing the effect of body position and positive airway pressures on regional lung ventilation in spontaneously breathing subjects. Intensive Care Med. 2005 Nov;31(11):1522-8. doi: 10.1007/s00134-005-2734-x. Epub 2005 Sep 30.
PubMed 16195908Stankiewicz-Rudnicki M, Gaszynski T, Gaszynski W. Assessment of regional ventilation in acute respiratory distress syndrome by electrical impedance tomography. Anaesthesiol Intensive Ther. 2015;47(1):77-81. doi: 10.5603/AIT.2015.0007.
PubMed 25751294Westerdahl E, Lindmark B, Eriksson T, Friberg O, Hedenstierna G, Tenling A. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest. 2005 Nov;128(5):3482-8. doi: 10.1378/chest.128.5.3482.
PubMed 16304303Rowley DD, Malinowski TP, Di Peppe JL, Sharkey RM, Gochenour DU, Enfield KB. A Randomized Controlled Trial Comparing Two Lung Expansion Therapies After Upper Abdominal Surgery. Respir Care. 2019 Oct;64(10):1181-1192. doi: 10.4187/respcare.06812. Epub 2019 May 21.
PubMed 31113857
Study at a glance
From the registry record, last updated by the sponsor on 19 Nov 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Controlled Trial Comparing the Effectiveness of Lung Expansion Therapy Following Upper Abdominal Surgery in Adult Human Subjects
- ClinicalTrials.gov ID
- NCT02892773
- Acronym / sponsor ID
- 19029
- Conditions
- Atelectasis
- Keywords
- electrical impedance tomography, incentive spirometry, EzPAP, lung volume, atelectasis, positive airway pressure, pulmonary complication, abdominal surgery
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 112 participants (actual)
- Lead sponsor
- University of VirginiaUniversity, hospital or other
- Collaborators
- Draeger Medical, Inc
- Study start
- Jan 2017
- Primary completion
- 12 Nov 2018 (actual)
- Study completion
- 12 Nov 2018 (actual)
- First posted
- 8 Sep 2016 (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 better understand how air is spread throughout study participants' lungs after abdominal surgery by comparing two lung inflation treatments:
- Incentive Spirometry (I.S.) lung expansion therapy
- EzPAP® lung expansion therapy.
Lung expansion therapy is routinely used after upper abdominal surgery. Taking deep breaths after surgery helps lungs to stay inflated. At the University of Virginia, it is at the physician's discretion as to which treatment will be used to help with deep breathing lung inflation therapy after surgery. The investigators would like to know which of the lung inflation therapies is better at helping inflate participants' lungs.
The investigators will be using a device called Electrical Impedance Tomography (EIT) to measure how effectively air spreads in participants' lungs. This device is not currently approved by the Food and Drug Administration (FDA) for the purpose used in this study, and therefore, it is considered investigational.
Investigators are inviting eligible participants to consider participating in this study because doctors order Incentive Spirometry as a standard of care following upper abdominal surgery. Information gained from monitoring how air is spread throughout participants' lungs will help investigators to determine if there is a clinical difference and benefit when comparing Incentive Spirometry and EzPAP lung expansion therapies.
Detailed description
Investigators will use a convenience sampling scheme to identify potential study participants. Documentation of informed consent will be recorded. Electrical Impedance Tomography (EIT), which provides non-invasive and radiation free monitoring, will be used to monitor and measure regional distribution of ventilation during Incentive Spirometry (I.S.) and EzPAP® lung expansion therapy. The PulmoVista 500 EIT device has a reported high patient safety profile and poses minimal patient risk.
The potential benefit for study participants will not be realized directly since the investigators' aim is to only monitor regional distribution of ventilation in response to I.S. or EzPAP® lung expansion therapy. While I.S. is considered to be a standard of post-operative care, there is low quality evidence documenting I.S. effectiveness in preventing pulmonary complications after upper abdominal surgery.
Loss of dorsal lung volume (i.e., atelectasis) is an example of a post-operative pulmonary complication. EzPAP® is a lung expansion therapy that is used as an alternative to I.S. lung expansion therapy for increasing dorsal regional lung volume (i.e., Functional Residual Volume [FRC]) in an effort to prevent or reverse atelectasis. When expiratory positive airway pressures of 5, 10, and 15 cmH2O was administered to a small group of healthy human subjects, medical researchers identified that a positive pressure of 15 cmH2O was associated with the greatest FRC increase when compared to zero pressure and baseline FRC measurements.
While study participants may not benefit directly from this study, investigators anticipate that important information will be gained from EIT monitoring of regional distribution of ventilation. Future upper abdominal post-operative surgical patients may benefit from this study's findings as investigators hope to advance clinical understanding associated with these therapies with use of EIT.
Procedure set-up and device calibration will occur according to Draeger provided PulmoVista 500 EIT training and operation manual instructions:
- Study participant preparation
- Investigators will assess the participant's thorax to ensure that the skin's surface is free of body fluids that may prevent or impede electrode contact. Skin surface will be wiped clean with a dry cloth if necessary.
- Investigators will select an electrode belt and respective patient cable sizes after measuring participant's chest circumference with paper measurement tape placed across the midclavicular line at intercostal space 4 -5. Electrode belt size will be selected according to chest circumference measurement.
- A patient cable of the same electrode belt size will be selected and connected to the electrode belt before connection to participant. Investigators will align and snap connect the patient cable snaps over the electrode belt studs by aligning respective snaps and studs in ascending numerical order from 1 to 16 .
- A light spray of water may be applied to the black electrode surface on the electrode belt before it is applied to participant if natural moisture from the skin does not result in sufficient conductivity between the skin and electrodes.
- Investigators will attach an electrode belt and reference electrode to participant while they are lying supine in bed. Participant's head of bed will be positioned at 45-degrees.
- The electrode belt/cable combination will be attached around the thorax of each participant at the level of the 4th - 5th intercostal space, unless mammary tissue prevents this site of application. An alternative application site will be located immediately below the mammary tissue if necessary. Left to right belt orientation will be maintained with color coded patient cable ports signifying left and right side.
- Investigators will snap the electrode belt closed after verifying proper belt position. The belt's black electrodes should have close contact with the study participant's skin at this point.
- An adhesive ECG electrode will be place on the study participant's right upper abdominal quadrant and then the patient cable reference electrode snap will be attached to the ECG electrode.
- The patient cable will then be connected to the EIT monitoring device via a color coded trunk cable orientation that aligns with the patient cable left and right orientation
- EIT device calibration and signal check
- Investigators will initiate a PulmonVista 500 EIT monitoring device calibration each day prior to performing new study participant end-expiratory lung impedance measurements.
- A skin-electrode signal check will be performed to ensure that a minimum of 15 of 16 electrodes have sufficient contact with the participant's skin surface and signal quality is stable. Investigators will use the following status display and explanation to determine adequacy of electrode contact and signal quality.
- Monitoring sessions and Lung Expansion Therapy procedure
- Monitoring will be initiated after investigators perform PulmoVista 500 EIT device setup and calibration prior to one of the three scheduled lung expansion therapy sessions on day 1, 3, and 5 (if not discharged from hospital) after surgery.
- Approximate monitoring/measurement duration is 15-minutes.
- Lung expansion therapies will occur as follows:
- Participants will be positioned supine in bed or bedside chair with head of bed or bedside chair positioned at 45-degrees.
Incentive Spirometry Procedure Group:
- A respiratory therapist will provide instruction on Incentive Spirometry procedure performance before supervised therapy and monitoring begins.
- Participants will be asked to take 10 deep breaths through the incentive spirometer's mouthpiece, followed by a 60 second pause.
- The 10-breath cycle will be repeated three times with respiratory therapist coaching.
- Each Incentive Spirometry therapy session will last about 15 minutes three times per day.
- EIT monitoring and deep breathing measurements will occur during one of the three scheduled Incentive Spirometry sessions on day 1, 3, and 5 (if not discharged from hospital) after surgery.
EzPAP® Positive Airway Pressure Group:
- A respiratory therapist will provide instruction on EzPAP® procedure performance before supervised therapy and monitoring begins.
- Participants will be asked to breathe normally through the EzPAP® device's mouthpiece for 10 breaths, followed by a 60 second pause.
- The 10-breath cycle will be repeated three times with respiratory therapist coaching.
- Each TID EzPAP® therapy sessions will last about 15 minutes three times per day.
- EIT monitoring and deep breathing measurements will occur during one of the three scheduled Incentive Spirometry sessions on day 1, 3, and 5 (if not discharged from hospital) after surgery.
- PulmoVista set-up and monitoring sessions will be coordinated in collaboration with each participant's bedside nurse and a respiratory therapist. Initial setup and monitoring commitment time is approximately 15 - 20 minutes.
- Electrical Impedance Tomography lung monitoring and measurements will occur during one of three scheduled EzPAP® therapies on day 1, 3, and 5 (if not discharged from hospital) after surgery. Participants will continue to receive respective lung expansion therapy as ordered three times per day, but without EIT monitoring.
- Regional distribution of ventilation information will be displayed on the PulmoVista 500 device's main monitoring screen during lung expansion therapy. Clinical staff administering therapy and participants will be blinded from information displayed on the screen's monitor in an effort to reduce performance bias.
- Once lung expansion therapy session has ended, investigators will detach trunk cables from electrode cables, detach reference electrode snap from adhesive ECG electrode, unclamp the electrode belt, and then remove belt from the participant.
- Investigators will inspect the electrode belt contact area to assess for evidence of skin irritation or bruising. Participant's physician will be notified of any significant findings.
- Displaying changes
- Once the PulmoVista 500 EIT device is removed from participant's room, the investigator will change from main screen view to Display change view. Regional distribution of ventilation information displayed on the PulmoVista 500 EIT device's screen will be used to record pre and post lung expansion therapy end-expiratory lung impedance changes.
- PulmoVista 500 EIT device will be removed participant's room and returned to a storage location outside of patient care areas.
- Following each EIT to participant interface disconnect, an alcohol, aldehyde, or quaternary ammonium based compound will be soaked on a wipe cloth to disinfect the surfaces of the patient cable, electrode belt, trunk cable, and EIT unit.
- Participant's head of bed will be returned to original position or to an elevation that is preferred by the participant after therapy and monitoring session is complete.
- Participant will continue with assigned lung expansion therapy as scheduled.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, care provider)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Incentive Spirometry Group | Other | Device: Incentive Spirometry* Participant will be asked to take 10 deep breaths through the mouthpiece of an incentive spirometer, followed by a 60 second pause. * This cycle will be repeated two more times. * A Respiratory Therapist will coach participants three times per day. * Each duration of Incentive Spirometry will last about 15 minutes. |
| EzPAP® Positive Airway Pressure Group | Active comparator | Device: EzPAP® Positive Airway Pressure* Participant will be coached by a Respiratory Therapist to breathe through the mouthpiece of an EzPAP® device for 10 breaths, followed by a 60 second pause. * This cycle will be repeated two more times. * The Respiratory Therapist will coach participants three times per day. * Each duration of EzPAP® therapy will last about 15 minutes. |
Who may qualify
- Ages
- 18 to 79 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (16 listed)
- Human subjects 18 - 79 years of age
- Post-operative upper abdominal surgery
- Laparotomy
- Biliodigestive anastomosis
- Cholecystectomy
Key exclusion criteria (19 listed)
- Less than 18 or greater than 79 years of age
- Anticipated post-operative hospital length of stay less than 3 days
- Body mass index > 50
- Excessive chest hair
- Inability to obtain written informed consent
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 |
|---|---|---|
| Incentive SpirometryA respiratory therapist will provide instruction on Incentive Spirometry (I.S.) procedure performance before supervised therapy and monitoring begins. * Study participants will be asked to take 10 deep breaths through the I.S.'s mouthpiece, followed by a 60 second pause. * The 10-breath cycle will be repeated 3 times per therapy session. * Each I.S. therapy session will last about 15 minutes, 3 times per day. * Lung monitoring and deep breathing measurements will occur during a scheduled I.S. sessions on day 1, 3, and 5 after surgery. | Device | Incentive Spirometry Group |
| EzPAP® Positive Airway PressureA respiratory therapist will provide instruction on EzPAP® procedure performance before supervised therapy and monitoring begins. * Study participants will be asked to breathe normally through the EzPAP® device's mouthpiece for 10 breaths, followed by a 60 second pause. * The 10-breath cycle will be repeated 3 times. * Each EzPAP® therapy sessions will last about 15 minutes, 3 times per day. * Lung monitoring will occur during a scheduled EzPAP® sessions on day 1, 3, and 5 after surgery. | Device | EzPAP® Positive Airway Pressure Group |
Primary outcome
Ventral and Dorsal end-expiratory lung impedance redistribution of ventilation
Time frame: Two years
EIT will be used to measure ventral and dorsal change in end-expiratory lung impedance before and after lung expansion therapy. Ventral and Dorsal lung impedance measurement is displayed on the EIT device as a percent (zero to 100). Investigators will record values into an electronic code book before and after lung expansion therapy. The difference between measured values will be used to quantify ventral and dorsal redistribution of ventilation. * Statistical analysis * An independent samples t-test or Mann-Whitney U test will be applied to determine if a statistically significant mean difference exists between groups. * Data will be reported as mean (SD) and 95% CI or median (IQR) depending upon normality of distribution. * Effect size = r (small effect </= 0.1; medium effect = 0.3; Large effect >/= 0.5 * Alpha set at ≤ 0.05 (two-tailed)
1 secondary outcome
Incidences of post-operative pulmonary complications
Time frame: Two years
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 19 Nov 2018.
- Background: PubMed 24510642do Nascimento Junior P, Modolo NS, Andrade S, Guimaraes MM, Braz LG, El Dib R. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev. 2014 Feb 8;2014(2):CD006058. doi: 10.1002/14651858.CD006058.pub3.
- Background: PubMed 12296888Fagevik Olsen M, Wennberg E, Johnsson E, Josefson K, Lonroth H, Lundell L. Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques. Br J Surg. 2002 Oct;89(10):1228-34. doi: 10.1046/j.1365-2168.2002.02207.x.
- Background: PubMed 363357Garrard CS, Shah M. The effects of expiratory positive airway pressure on functional residual capacity in normal subjects. Crit Care Med. 1978 Sep-Oct;6(5):320-2. doi: 10.1097/00003246-197809000-00004.
- Background: PubMed 12853539Hinz J, Neumann P, Dudykevych T, Andersson LG, Wrigge H, Burchardi H, Hedenstierna G. Regional ventilation by electrical impedance tomography: a comparison with ventilation scintigraphy in pigs. Chest. 2003 Jul;124(1):314-22. doi: 10.1378/chest.124.1.314.
- Background: PubMed 26743570Karsten J, Stueber T, Voigt N, Teschner E, Heinze H. Influence of different electrode belt positions on electrical impedance tomography imaging of regional ventilation: a prospective observational study. Crit Care. 2016 Jan 8;20:3. doi: 10.1186/s13054-015-1161-9.
- Background: PubMed 25973670Lunardi AC, Paisani DM, Silva CCBMD, Cano DP, Tanaka C, Carvalho CRF. Comparison of lung expansion techniques on thoracoabdominal mechanics and incidence of pulmonary complications after upper abdominal surgery: a randomized and controlled trial. Chest. 2015 Oct;148(4):1003-1010. doi: 10.1378/chest.14-2696.
- Background: PubMed 17653529Meier T, Luepschen H, Karsten J, Leibecke T, Grossherr M, Gehring H, Leonhardt S. Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography. Intensive Care Med. 2008 Mar;34(3):543-50. doi: 10.1007/s00134-007-0786-9. Epub 2007 Jul 25.
- Background: PubMed 26329355Parke RL, Bloch A, McGuinness SP. Effect of Very-High-Flow Nasal Therapy on Airway Pressure and End-Expiratory Lung Impedance in Healthy Volunteers. Respir Care. 2015 Oct;60(10):1397-403. doi: 10.4187/respcare.04028. Epub 2015 Sep 1.
- Background: PubMed 16195908Riedel T, Richards T, Schibler A. The value of electrical impedance tomography in assessing the effect of body position and positive airway pressures on regional lung ventilation in spontaneously breathing subjects. Intensive Care Med. 2005 Nov;31(11):1522-8. doi: 10.1007/s00134-005-2734-x. Epub 2005 Sep 30.
- Background: PubMed 25751294Stankiewicz-Rudnicki M, Gaszynski T, Gaszynski W. Assessment of regional ventilation in acute respiratory distress syndrome by electrical impedance tomography. Anaesthesiol Intensive Ther. 2015;47(1):77-81. doi: 10.5603/AIT.2015.0007.
- Background: PubMed 16304303Westerdahl E, Lindmark B, Eriksson T, Friberg O, Hedenstierna G, Tenling A. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest. 2005 Nov;128(5):3482-8. doi: 10.1378/chest.128.5.3482.
- Derived from this study: PubMed 31113857Rowley DD, Malinowski TP, Di Peppe JL, Sharkey RM, Gochenour DU, Enfield KB. A Randomized Controlled Trial Comparing Two Lung Expansion Therapies After Upper Abdominal Surgery. Respir Care. 2019 Oct;64(10):1181-1192. doi: 10.4187/respcare.06812. Epub 2019 May 21.
- Individual participant dataSharing planned: Yes. Intend to submit overall study findings to peer reviewed medical journal after study completion.
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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.
Daniel D Rowley, MSc RRT-ACCS principal investigator
Pulmonary Diagnostics & Respiratory Therapy Services, University of Virginia Medical Center
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Incentive Spirometry and EzPAP® Positive Airway Pressure in people with Atelectasis, run by University of Virginia at 1 site in United States.
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 16 inclusion and 19 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 19 Nov 2018. 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 United States. 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?
Ventral and Dorsal end-expiratory lung impedance redistribution of ventilation (time frame: Two years). 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 NCT02892773, which also lists 12 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 19 Nov 2018.