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Acute Severe Respiratory FailureCO2 LUNG SAFENCT03415529

Impact of Arterial CO2 Tension on Management and Outcome in Patients With Acute Hypoxemic Respirator Failure and ARDS

An observational study of Acute Severe Respiratory Failure and Acute Respiratory Distress Syndrome, run by European Society of Intensive Care Medicine at 1 site in Belgium.

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

There appears to be considerable variability in the approach physicians use to manage arterial carbon dioxide tensions, in patients in the early phases [first 48 hours] of ARDS (Acute hypoxemic respiratory failure and). Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
How many people
4,500 participants
Where
1 siteBelgium
Study dates
1 Mar 2018to 30 Dec 2018
Phase
Observational
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
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Patients over 18 years of age who fulfilled clinical criteria for ARDS and Acute Hypoxaemic respiratory failure were recruited into the LUNG SAFE trial (NCT02010073) that was published in JAMA, 2016 Jul 19;316(3):347).

Who may be able to join

  • All patients meeting criteria for ARDS. Fulfillment of criteria for Acute Hypoxaemic respiratory failure (AHRF) and fulfillment of Berlin criteria for ARDS during the first two days after AHRF onset.

Who cannot join

  • Age < 18

Trial locations and contacts

1 site in 1 country.

Belgium1 site
  • Guy Marie FRANCOIS

    Brussels

Other trials in Belgium

About this study

Official title: Incidence of Hypercapnia and Impact of Arterial CO2 Tension on Management and Outcome in Patients With Acute Respiratory Distress Syndrome (ARDS)

There appears to be considerable variability in the approach physicians use to manage arterial carbon dioxide tensions, in patients in the early phases [first 48 hours] of ARDS (Acute hypoxemic respiratory failure and). A number of specific concerns exist, particularly the use of greater than needed inspired oxygen concentrations (potentially in 40% patients), and the proportion of hypocapnic patients in our cohort.

Read the detailed description

This study will address a number of specific concerns, including:

  1. the incidence of hypocapnia and hypercapnia;
  2. the factors (e.g. ventilatory mode) contributing to hypocapnia and hypercapnia;
  3. the impact of hypocapnia and hypercapnia on progression of ARDS, duration of ventilation, ICU stay, hospital stay and patient outcome;
  4. the impact of pH (respiratory versus metabolic cause) on outcome variables.

LUNG SAFE was a prospective observational study. There was not patient intervention. The current analysis is a secondary analysis of this existing database.

Data will be abstracted form the database on all patients meeting the inclusion criteria for ARDS (during the first 2 days from AHRF onset) for the following variables: Patient's demographic characteristics (age, sex) and chronic comorbidities, Arterial PCO2, pH in first 48 hours, Data on P/F ratio over course of illness, Duration of ventilation, ICU stay, hospital survival in patients identified as being exposed to hypocapnia (pCO2 < or = to 30mmHg) and hypercapnia (PCO2 > or = to 45mmHg); Main ventilatory variables: mode of ventilation, tidal volume, respiratory.

Descriptive statistics will include proportions for categorical and mean (standard deviation) or median (interquartile range) for continuous variables, according the data distribution. The amount of missing data in the LUNG SAFE database is low so no assumptions will be made for missing data.

In order to investigate the relationship between PaCO2 and management factors, the investigators will stratify study population according the presence or absence of hypercapnia and will evaluate differences in management factors, using appropriate statistical tests. In detail, proportions will be compared using chi-squared or Fisher exact tests and mean values were compared using T-test or Wilcoxon rank sum test, as appropriate. Shapiro-Wilks test will be used to assess normality in data distribution. Moreover, they will perform univariate and multivariable logistic regression models using hypercapnia as dependent variable. Stepwise regression approach with significance alpha levels of 0.05 (both for entry and retention) will be used to establish a set of independent predictors. Odds ratios (ORs) and 95% confidence intervals (CIs) will be reported as measure of association.

They will assess the association of hypercapnia with different outcomes (ARDS progression, duration of mechanical ventilation, ICU and hospital stay and mortality) using generalized linear regression models (Poisson or Logistic regression models, according outcome distribution) and adjusting the relationship with all possible confounders identified with stepwise approach. Results will be reported as ORs, incidence rate ratios and corresponding 95% CI.

Particular attention will be given to the relationship and interaction between pH and PaCO2.

Survival analysis (Kaplan-Meier approach) will be used to estimate the time of liberation from invasive mechanical ventilation, of ICU and hospital discharge, and of hospital mortality within 28 days of AHRF onset in patients with and without hypercapnia. Differences in survival time will be assess by Log-Rank test.

Keywords
Lung, ARDS, Acute Respiratory Syndrome, Prognosis, Outcome Research, Respiratory infection, Sepsis, Organ failure, Hypercapnia
Medical subject headings
Respiratory Distress Syndrome, Respiratory Tract Infections, Sepsis, Hypercapnia

What participants receive

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

Study groups in NCT03415529
Study groupRoleWhat they receive
4500 patients with ARDSThis is a secondary analysis of data from the LUNG SAFE database to determine the impact of alterations in arterial carbon dioxide tensions in patients with ARDS.

What is being measured

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

  1. Incidence

    The incidence of hypercapnia [i.e. PaCO2 > 45 mmHg] when ARDS arises

    Measured: LUNG SAFE was a prospective observational study. Patients were followed until hospital discharge or day 90, whichever came first

Secondary outcomes (4)
  1. Severity

    The severity of hypercapnia [i.e. PaCO2 > 45 mmHg] when ARDS arises ARDS

    Measured: LUNG SAFE was a prospective observational study. Patients were followed until hospital discharge or day 90, whichever came first

  2. Hypercapnia

    Factors (e.g. ventilatory mode) contributing to hypercapnia in patients with ARDS

    Measured: LUNG SAFE was a prospective observational study. Patients were followed until hospital discharge or day 90, whichever came first

  3. Hypercapnia

    The impact of hypercapnia on outcome on the progression of ARDS

    Measured: LUNG SAFE was a prospective observational study. Patients were followed until hospital discharge or day 90, whichever came first

  4. pH ((potential of hydrogen)

    The impact of pH (respiratory versus metabolic cause) on outcome variables

    Measured: LUNG SAFE was a prospective observational study. Patients were followed until hospital discharge or day 90, whichever came first

Timeline

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

  1. First posted30 Jan 2018
  2. Study start1 Mar 2018
  3. Primary completion30 Sep 2018
  4. Study completion30 Dec 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
4,500 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03415529
Sponsor's protocol ID
CO2LUNGSAFE
Acronym
CO2 LUNG SAFE
Status last verified
Aug 2019
First submitted
17 Jan 2018
Last updated
14 Aug 2019
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson BT, Wrigge H, Slutsky AS, Pesenti A; LUNG SAFE Investigators; ESICM Trials Group. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016 Feb 23;315(8):788-800. doi: 10.1001/jama.2016.0291.

    PubMed 26903337
  • Laffey JG, Bellani G, Pham T, Fan E, Madotto F, Bajwa EK, Brochard L, Clarkson K, Esteban A, Gattinoni L, van Haren F, Heunks LM, Kurahashi K, Laake JH, Larsson A, McAuley DF, McNamee L, Nin N, Qiu H, Ranieri M, Rubenfeld GD, Thompson BT, Wrigge H, Slutsky AS, Pesenti A; LUNG SAFE Investigators; ESICM Trials Group. Correction to: Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. 2018 Jan;44(1):157-165. doi: 10.1007/s00134-017-4981-z.

    PubMed 29138899
  • de Prost N, Pham T, Carteaux G, Mekontso Dessap A, Brun-Buisson C, Fan E, Bellani G, Laffey J, Mercat A, Brochard L, Maitre B; LUNG SAFE investigators; ESICM trials group; REVA network. Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study. Ann Intensive Care. 2017 Dec;7(1):69. doi: 10.1186/s13613-017-0281-6. Epub 2017 Jun 19.

    PubMed 28631088
  • Laffey JG, Madotto F, Bellani G, Pham T, Fan E, Brochard L, Amin P, Arabi Y, Bajwa EK, Bruhn A, Cerny V, Clarkson K, Heunks L, Kurahashi K, Laake JH, Lorente JA, McNamee L, Nin N, Palo JE, Piquilloud L, Qiu H, Jimenez JIS, Esteban A, McAuley DF, van Haren F, Ranieri M, Rubenfeld G, Wrigge H, Slutsky AS, Pesenti A; LUNG SAFE Investigators; ESICM Trials Group. Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study. Lancet Respir Med. 2017 Aug;5(8):627-638. doi: 10.1016/S2213-2600(17)30213-8. Epub 2017 Jun 15.

    PubMed 28624388
  • Dreyfuss D, Gaudry S, Madotto F, Laffey JG. Some remaining important questions after LUNG SAFE : Discussion of "Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study". Intensive Care Med. 2017 Apr;43(4):598-599. doi: 10.1007/s00134-017-4706-3. Epub 2017 Feb 17. No abstract available.

    PubMed 28213623
  • Laffey JG, Bellani G, Pham T, Fan E, Madotto F, Bajwa EK, Brochard L, Clarkson K, Esteban A, Gattinoni L, van Haren F, Heunks LM, Kurahashi K, Laake JH, Larsson A, McAuley DF, McNamee L, Nin N, Qiu H, Ranieri M, Rubenfeld GD, Thompson BT, Wrigge H, Slutsky AS, Pesenti A; LUNG SAFE Investigators and the ESICM Trials Group. Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. 2016 Dec;42(12):1865-1876. doi: 10.1007/s00134-016-4571-5. Epub 2016 Oct 18.

    PubMed 27757516
  • Bellani G, Laffey JG, Pham T, Madotto F, Fan E, Brochard L, Esteban A, Gattinoni L, Bumbasirevic V, Piquilloud L, van Haren F, Larsson A, McAuley DF, Bauer PR, Arabi YM, Ranieri M, Antonelli M, Rubenfeld GD, Thompson BT, Wrigge H, Slutsky AS, Pesenti A; LUNG SAFE Investigators; ESICM Trials Group. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med. 2017 Jan 1;195(1):67-77. doi: 10.1164/rccm.201606-1306OC.

    PubMed 27753501
  • Bellani G, Laffey JG, Pham T, Fan E; LUNG SAFE Investigators and the ESICM Trials Group. The LUNG SAFE study: a presentation of the prevalence of ARDS according to the Berlin Definition! Crit Care. 2016 Sep 9;20(1):268. doi: 10.1186/s13054-016-1443-x. No abstract available.

    PubMed 27608629
  • Bellani G, Pham T, Laffey J; LUNG-SAFE Investigators; ESICM Trials Group. Incidence of Acute Respiratory Distress Syndrome--Reply. JAMA. 2016 Jul 19;316(3):347. doi: 10.1001/jama.2016.6471. No abstract available.

    PubMed 27434453

Questions about this trial

What is this clinical trial studying?

An observational study of Acute Severe Respiratory Failure and Acute Respiratory Distress Syndrome, run by European Society of Intensive Care Medicine at 1 site in Belgium.

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 1 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 14 Aug 2019. 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 Belgium. 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?

Incidence (time frame: LUNG SAFE was a prospective observational study. Patients were followed until hospital discharge or day 90, whichever came first). 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 NCT03415529, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Aug 2019.

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