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Chronic Obstructive Pulmonary DiseaseNCT03466385

NHF vs NIV in Patients With Acute Exacerbation of COPD

A study testing Nasal High Flow and Non-Invasive Ventilation in people with Chronic Obstructive Pulmonary Disease and Respiratory Failure, run by Evangelismos Hospital at 3 sites in Greece.

Unknown status

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 The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Although non-invasive ventilation (NIV) usage has increased significantly over time in COPD exacerbation, a great percentage of patients (~30%) present contraindications to NIV or cannot tolerate it. Read more about this study

Who is it for?
Ages 40 to 85 years
What is being tested?
Nasal High Flow and Non-Invasive Ventilation
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
498 participants
Where
3 sitesGreece
Study dates
15 Apr 2018to 31 Dec 2021
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 40 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient with mild to moderate COPD exacerbation and the following characteristics persisting after initial medical therapy with bronchodilators and controlled oxygen therapy
  • 7,25<pH<7,35
  • PaCO2>45mmHg
  • RR>23
  • Ability to obtain written informed consent by the patient or patient's next of kin

Who cannot join

  • severe facial deformity
  • Facial burns
  • Fixed upper airway obstruction
  • Criteria for imminent intubation and invasive mechanical ventilation (any of the following)
  • respiratory or cardiac arrest
  • gasping respiration
Show all 14Show fewer
  • pH <7.15
  • depressed consciousness (Glasgow Coma Score <8)
  • psychomotor agitation inadequately controlled by sedation
  • massive aspiration
  • persistent inability to remove respiratory secretions
  • heart rate < 50 ·min-1 with loss of alertness
  • severe hemodynamic instability without response to fluids and vasoactive drugs
  • severe ventricular arrhythmias

Trial locations and contacts

3 sites in 1 country.

Eleni Ischaki, MD, PhD contact

+306974856544

eischaki@yahoo.gr

Greece3 sites, 3 recruiting
  • Evangelismos Hospital

    Athens, 10673

    Eleni Ischaki, +306974856544, eischaki@yahoo.gr

    Recruiting
  • Venizeleio Hospital

    Heraklion, Crete, 71409

    Ioannis Pantazopoulos, +306945661525, pantazopoulosioannis@yahoo.com

    Recruiting
  • University General Hospital of Larisa

    Larissa, 41110

    Stratos Manoulakas, stratosfox@hotmail.com

    Recruiting

Other trials in Greece

About this study

Official title: Nasal High Flow Versus Non-Invasive Ventilation in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Although non-invasive ventilation (NIV) usage has increased significantly over time in COPD exacerbation, a great percentage of patients (~30%) present contraindications to NIV or cannot tolerate it. Nasal high flow (NHF) has been introduced for the management of hypoxemic respiratory failure in adults with favorable effects on ventilation and respiratory mechanics. The above mentioned NHF positive effects has been observed also in stable COPD patients with or without chronic hypercapnia.

In this study, the investigators hypothesize that NHF is not inferior to NIV for respiratory support in patients with COPD exacerbation and acute or acute on chronic hypercapnic respiratory failure.

Read the detailed description

The use of non-invasive ventilation (NIV) in COPD exacerbation has increased significantly over time since it has been shown to improve acute respiratory acidosis (increases pH and decreases PaCO2), decrease respiratory rate, work of breathing, severity of breathlessness and therefore reduce mortality and intubation rates.

Despite all these favorable effect, a great percentage of patients (~30%) present contraindications to NIV or cannot tolerate it increasing thus the possibility of NIV failure and consequently intubation rates.

Over the past decade, nasal high flow (NHF) oxygen therapy has been introduced for the management of hypoxemic respiratory failure in adults. NHF can generate high flow rates up to 60 L·min-1 and through this mechanism exerts its positive effects on respiratory mechanics, carbon dioxide washout, patient's respiratory rate and work of breathing. Although the above mentioned NHF positive effects has been observed also in stable COPD patients with or without chronic hypercapnia, NHF use in COPD exacerbation is questionable and only a few case reports studies have been published showing favorable effects of NHF on COPD exacerbation.

In this study, the investigators hypothesize that NHF is not inferior to NIV for respiratory support in patients with COPD exacerbation and acute or acute on chronic hypercapnic respiratory failure.

Being tested
Nasal High Flow, Non-Invasive Ventilation
Keywords
Non-invasive ventilation, Nasal High Flow
Medical subject headings
Pulmonary Disease, Chronic Obstructive, Respiratory Insufficiency

What participants receive

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

  • Nasal High FlowDevice

    Patients admitted to emergency department with COPD exacerbation combined with mild to moderate acute or acute on chronic hypercapnic respiratory failure will be randomized in one of the two study groups. In case of NHF it will be commence immediately with pre-defined settings

  • Non-Invasive VentilationDevice

    Patients admitted to emergency department with COPD exacerbation combined with mild to moderate acute or acute on chronic hypercapnic respiratory failure will be randomized in one of the two study groups. In case of NIV it will be commence immediately with pre-defined settings

Study groups in NCT03466385
Study groupRoleWhat they receive
Nasal High FlowExperimentalPatients randomized to NHF device with initial settings of flow=50-60 L·min-1, temperature=37ο Celsius and FiO2 adjusted to maintain SpO2 between 88%-92%.
Receives: Device: Nasal High Flow
Non-Invasive VentilationActive comparatorPatients randomized to NIV with initial settings EPAP=3cmH2O, IPAP=15cmH2O, I:E=1:2 to 1:3, inspiratory time=0.8-1.2sec and FiO2 adjusted to maintain SpO2 between 88%-92%.
Receives: Device: Non-Invasive Ventilation

What is being measured

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

  1. Frequency of treatment failure

    As treatment failure is defined any need to switch to other treatment group because of discomfort, intolerance or failure to improve physiologic parameters (especially respiratory rate and ABG) despite optimum settings

    Measured: The first assessment will be held at 2 hours

Secondary outcomes (8)
  1. Changes on respiratory rate

    This secondary outcome includes changes on respiratory rate (breaths per minute)

    Measured: They will be assessed on baseline, before NIV or NHF initiation, and on 1, 2, 4, 6, 12, 24, 48 hours and once daily after day 3.

  2. Changes on arterial partial pressure of oxygen

    This secondary outcome includes changes on arterial partial pressure of oxygen values (unit of measure will be mmHg)

    Measured: They will be assessed on baseline, before NIV or NHF initiation, and on 1, 2, 4, 6, 12, 24, 48 hours and once daily after day 3.

  3. Changes on arterial partial pressure of carbon dioxide

    This secondary outcome includes changes on arterial partial pressure of carbon dioxide (unit of measure will be mmHg)

    Measured: They will be assessed on baseline, before NIV or NHF initiation, and on 1, 2, 4, 6, 12, 24, 48 hours and once daily after day 3.

  4. Changes on arterial pH

    This secondary outcome includes changes on arterial pH values

    Measured: They will be assessed on baseline, before NIV or NHF initiation, and on 1, 2, 4, 6, 12, 24, 48 hours and once daily after day 3.

  5. Changes on respiratory accessory muscle use

    This secondary outcome includes recording of respiratory accessory muscle use (recording will be yes or no)

    Measured: They will be assessed on baseline, before NIV or NHF initiation, and on 1, 2, 4, 6, 12, 24, 48 hours and once daily after day 3.

  6. Patient's dyspnea

    Dyspnea will be assessed with a 10-point visual analog scale and also Borg scale for dyspnea

    Measured: They will be assessed on baseline, before NIV or NHF initiation, and on 1, 2, 4, 6, 12, 24, 48 hours and once daily after day 3 (in those subjects whose neurological status allowed them to complete the evaluation)

  7. Pulmonary complications

    Any pulmonary complication will be assessed and correlated with the allocated treatment

    Measured: They will be assessed on baseline, before NIV or NHF initiation, and on 1, 2, 4, 6, 12, 24, 48 hours and once daily after day 3.

  8. Extrapulmonary complications

    Any extrapulmonary complication will be assessed and correlated with the allocated treatment

    Measured: They will be assessed on baseline, before NIV or NHF initiation, and on 1, 2, 4, 6, 12, 24, 48 hours and once daily after day 3

Timeline

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

  1. First posted15 Mar 2018
  2. Study start15 Apr 2018
  3. Primary completion31 Dec 2020 (estimated)
  4. Study completion31 Dec 2021 (estimated)

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
498 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03466385
Sponsor's protocol ID
48/28-02-2018
Status last verified
Feb 2020
First submitted
28 Feb 2018
Last updated
20 Feb 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Information that are planned to be shared re study protocol, statistical analysis and clinical study report. They will be shared after 3 months of study publication to anyone who is interested in writing a meta-analysis or review

Publications

  • Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, Church AC, Creagh-Brown B, Dodd JW, Felton T, Foex B, Mansfield L, McDonnell L, Parker R, Patterson CM, Sovani M, Thomas L; BTS Standards of Care Committee Member, British Thoracic Society/Intensive Care Society Acute Hypercapnic Respiratory Failure Guideline Development Group, On behalf of the British Thoracic Society Standards of Care Committee. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax. 2016 Apr;71 Suppl 2:ii1-35. doi: 10.1136/thoraxjnl-2015-208209. No abstract available.

    PubMed 26976648
  • Ischaki E, Pantazopoulos I, Zakynthinos S. Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device. Eur Respir Rev. 2017 Aug 9;26(145):170028. doi: 10.1183/16000617.0028-2017. Print 2017 Sep 30.

    PubMed 28794144
  • Mauri T, Turrini C, Eronia N, Grasselli G, Volta CA, Bellani G, Pesenti A. Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med. 2017 May 1;195(9):1207-1215. doi: 10.1164/rccm.201605-0916OC.

    PubMed 27997805
  • Fricke K, Tatkov S, Domanski U, Franke KJ, Nilius G, Schneider H. Nasal high flow reduces hypercapnia by clearance of anatomical dead space in a COPD patient. Respir Med Case Rep. 2016 Aug 26;19:115-7. doi: 10.1016/j.rmcr.2016.08.010. eCollection 2016.

    PubMed 27668173
  • Biselli PJ, Kirkness JP, Grote L, Fricke K, Schwartz AR, Smith P, Schneider H. Nasal high-flow therapy reduces work of breathing compared with oxygen during sleep in COPD and smoking controls: a prospective observational study. J Appl Physiol (1985). 2017 Jan 1;122(1):82-88. doi: 10.1152/japplphysiol.00279.2016. Epub 2016 Nov 4.

    PubMed 27815367
  • Braunlich J, Seyfarth HJ, Wirtz H. Nasal High-flow versus non-invasive ventilation in stable hypercapnic COPD: a preliminary report. Multidiscip Respir Med. 2015 Sep 3;10(1):27. doi: 10.1186/s40248-015-0019-y. eCollection 2015.

    PubMed 26339486
  • Fraser JF, Spooner AJ, Dunster KR, Anstey CM, Corley A. Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: a randomised crossover trial. Thorax. 2016 Aug;71(8):759-61. doi: 10.1136/thoraxjnl-2015-207962. Epub 2016 Mar 25.

    PubMed 27015801
  • Pisani L, Fasano L, Corcione N, Comellini V, Musti MA, Brandao M, Bottone D, Calderini E, Navalesi P, Nava S. Change in pulmonary mechanics and the effect on breathing pattern of high flow oxygen therapy in stable hypercapnic COPD. Thorax. 2017 Apr;72(4):373-375. doi: 10.1136/thoraxjnl-2016-209673. Epub 2017 Jan 19.

    PubMed 28104830
  • Lepere V, Messika J, La Combe B, Ricard JD. High-flow nasal cannula oxygen supply as treatment in hypercapnic respiratory failure. Am J Emerg Med. 2016 Sep;34(9):1914.e1-2. doi: 10.1016/j.ajem.2016.02.020. Epub 2016 Feb 12. No abstract available.

    PubMed 26947372
  • Pantazopoulos I, Boutlas S, Mavrovounis G, Papalampidou A, Papagiannakis N, Kontou M, Bibaki E, Athanasiou N, Meletis G, Gourgoulianis K, Zakynthinos S, Ischaki E. Nasal high flow or noninvasive ventilation? navigating hypercapnic COPD exacerbation treatment: A randomized noninferiority clinical trial. Respir Med. 2024 Oct;232:107762. doi: 10.1016/j.rmed.2024.107762. Epub 2024 Aug 5.

    PubMed 39111544

Questions about this trial

What is this clinical trial studying?

A study testing Nasal High Flow and Non-Invasive Ventilation in people with Chronic Obstructive Pulmonary Disease and Respiratory Failure, run by Evangelismos Hospital at 3 sites in Greece.

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 5 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 20 Feb 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Greece. 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?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Eleni Ischaki, MD, PhD (+306974856544, eischaki@yahoo.gr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Frequency of treatment failure (time frame: The first assessment will be held at 2 hours). 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 NCT03466385, which also lists 10 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 20 Feb 2020.

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