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Mechanical Ventilation ComplicationTWEEPNCT03856424

Effect of Three Modalities of Spontaneous Breathing Tests on Respiratory Efforts in Tracheostomized Patients

A study testing Modality 1, Modality 2 and Modality 3 in people with Mechanical Ventilation Complication, run by Piquilloud Imboden Lise at 1 site in Switzerland.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Datas are lacking concerning weaning from mechanical ventilation for tracheostomized patients. In particular, the effect of different modalities of spontaneous breathing trials on respiratory effort has not been extensively described. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Mechanical Ventilation Complication
What is being tested?
Modality 1, Modality 2 and Modality 3
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
18 participants
Where
1 siteSwitzerland
Study dates
8 Mar 2019to 30 Dec 2023
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients for whom a tracheostomy is planned
  • Patients on invasive ventilation for >72 hours

Who cannot join

  • Tracheostomy for upper airway obstruction or other disease
  • Patients tracheostomized before current hospitalization
  • Patients with Glasgow Coma Scale (GCS) < 8/10 after cardiac arrest
  • Patients with GCS < 8/10 because of primary central neurologic disease
  • Patients for whom therapeutic limitations have already been decided
  • Patients for whom weaning from ventilation is not an objective
Show all 10Show fewer
  • Patients suffering from myasthenia gravis
  • Patients with cardiac assistance device
  • Patients with medullary lesion proximal to C5
  • Patients for whom nasogastric tube insertion is contraindicated

Trial locations and contacts

1 site in 1 country.

Lise Piquilloud Imboden, MER&PD contact

+41 79 556 68 27

lise.piquilloud@chuv.ch

Switzerland1 site, 1 recruiting
  • Lausanne University Hospitals

    Lausanne, Canton of Vaud, 1011

    Lise Piquilloud Imboden, PD&MER, +41 79 556 68 27, lise.piquilloud@chuv.ch

    Recruiting

Other trials in Switzerland

About this study

Official title: Effect of Three Modalities of Spontaneous Breathing Tests on Respiratory Efforts in Tracheostomized Patients. Monocentric Crossover Interventionnal Study.

Datas are lacking concerning weaning from mechanical ventilation for tracheostomized patients. In particular, the effect of different modalities of spontaneous breathing trials on respiratory effort has not been extensively described.

This crossover physiology study will include 18 tracheostomized patients ventilated for more than 72 hours.

The objective of this study is to compare the effect of three different modalities of SBTs on respiratory effort in tracheostomized patients. The modalities tested are : Pressure Support Ventilation (PSV level 5 cmH2O, PEEP 5 cmH2O), T-piece test and high-flow Oxygen. Each modality is applied in a randomized order, during 30 minutes. During every modality tested, esophageal and gastric pressure, expired CO2, and comfort will be monitored, in addition to standard monitoring. Based on esophageal pressure monitoring, patient's respiratory efforts can be calculated either by esophageal pressure-time product and work of breathing. Pressure generated by inspiratory muscles will also be assessed.

Being tested
Modality 1, Modality 2, Modality 3
Keywords
Ventilation, Tracheotomy, Difficult weaning, Spontaneous Breathing Test, Esophageal pressure, Work of breathing, Esophageal pressure time-product, Difficult weaning from mechanical ventilation, Ventilation weaning
Medical subject headings
Respiratory Aspiration

What participants receive

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

  • Modality 1Procedure or surgery

    Pressure support ventilation (PSV) modality

  • Modality 2Procedure or surgery

    T-Piece modality

  • Modality 3Procedure or surgery

    High-flow oxygen

Study groups in NCT03856424
Study groupRoleWhat they receive
Modality 1 - Washout - Modality 2 - Washout - Modality 3OtherThree different 30-minute modalities of deventilation will be performed in a randomized order in each patient. Washout periods of 30 minutes will occur between tested modalities.
Receives: Procedure: Modality 1; Procedure: Modality 2; Procedure: Modality 3
Modality 1 - Washout - Modality 3 - Washout - Modality 2OtherThree different 30-minute modalities of deventilation will be performed in a randomized order in each patient. Washout periods of 30 minutes will occur between tested modalities.
Receives: Procedure: Modality 1; Procedure: Modality 2; Procedure: Modality 3
Modality 2 - Washout - Modality 1 - Washout - Modality 3OtherThree different 30-minute modalities of deventilation will be performed in a randomized order in each patient. Washout periods of 30 minutes will occur between tested modalities.
Receives: Procedure: Modality 1; Procedure: Modality 2; Procedure: Modality 3
Modality 2 - Washout - Modality 3 - Washout - Modality 1OtherThree different 30-minute modalities of deventilation will be performed in a randomized order in each patient. Washout periods of 30 minutes will occur between tested modalities.
Receives: Procedure: Modality 1; Procedure: Modality 2; Procedure: Modality 3
Modality 3 - Washout - Modality 2 - Washout - Modality 1OtherThree different 30-minute modalities of deventilation will be performed in a randomized order in each patient. Washout periods of 30 minutes will occur between tested modalities.
Receives: Procedure: Modality 1; Procedure: Modality 2; Procedure: Modality 3
Modality 3 - Washout - Modality 1 - Washout - Modality 2OtherThree different 30-minute modalities of deventilation will be performed in a randomized order in each patient. Washout periods of 30 minutes will occur between tested modalities.
Receives: Procedure: Modality 1; Procedure: Modality 2; Procedure: Modality 3

What is being measured

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

  1. Evolution of pressure-time product of esophageal pressure

    Quantification of inspiratory effort of the patient

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

Secondary outcomes (27)
  1. Evolution of work of breathing (WOB)

    Total area of a Campbell diagram for esophageal pressure and volume during one respiratory cycle

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  2. Evolution of esophageal pressure drop

    Maximum variation of esophageal pressure during respiratory cycles

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  3. Evolution of inspiratory muscle pressure (Pmus)

    Pressure generated by patients' respiratory muscles

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  4. Evolution of transdiaphragmatic pressure (Ptransdiaph)

    Difference between gastric and esophageal pressure. Reflect of pressure generated by diaphragm during inspiration

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  5. Evolution of tidal volume (VT)

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  6. Evolution of respiratory rate (RR)

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  7. Evolution of inspiratory airway flow

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  8. Evolution of ratio of inspiratory time over total duration of a breathing cycle (ti/ttot)

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  9. Evolution of Rapid Shallow Breathing Index (RSBI)

    RR/VT - predictor during ventilation weaning of intolerance of SBT

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  10. Evolution of respiratory system compliance (Crs)

    Capacity of total respiratory system to gain volume for a given pressure

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  11. Evolution of lungs compliance (CL)

    Capacity of lungs to gain volume for a given pressure

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  12. Evolution of chest wall compliance (Ccw)

    Capacity of lungs to gain volume for a given pressure

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  13. Evolution of transpulmonary pressure (Ptranspulm)

    Alveolar pressure minus pleural pressure

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  14. Evolution of ratio of total dead space volume over tidal volume

    Calculated by means of expired CO2 and arterial blood gas CO2

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  15. Evolution of total dead space volume

    Calculated by means of expired CO2

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  16. Evolution of total Positive End-Expiratory Pressure (PEEPtot)

    Airway pressure during end-expiratory ventilator occlusion

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  17. Evolution of heart rate

    Standard monitoring

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  18. Evolution of blood pressure

    Standard monitoring

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  19. Evolution of Plateau pressure (Pplat)

    Airway pressure during end-inspiratory ventilator occlusion (corresponds to alveolar pressure)

    Measured: Recorded at minute 1 and minute 30 of each three spontaneous Breathing Trial, 90 minutes

  20. Evolution of intrinsic Positive End-Expiratory Pressure (PEEPi)

    PEEPi minus PEEP set on ventilator

    Measured: Recorded at minute 1 and minute 30 of each three spontaneous Breathing Trial, 90 minutes

  21. Pulmonary strain

    Measured as the ratio of tidal volume over functionnal residual capacity (FRV)

    Measured: Recorded every 5 minutes during each sequence and washout period, 180 minutes

  22. Evolution of Diaphragmatic excursion (DE)

    Ultrasound measurement of diaphragm movement during inspiration

    Measured: Recorded at minute 1 and minute 30 of each three spontaneous Breathing Trial, 90 minutes

  23. Evolution of Diaphragmatic thickening fraction (DTF)

    Ultrasound measurement of diaphragm thickening during inspiration

    Measured: Recorded at minute 1 and minute 30 of each three spontaneous Breathing Trial, 90 minutes

  24. Evolution of hematocrits

    Mesured by arterial blood

    Measured: Recorded at minute 30 of each three spontaneous Breathing Trial, 90 minutes

  25. Evolution of Richmond Agitation/Sedation scale (RASS) score

    Used in ICU to monitor neurologic changes in patients. Scale from -5 (unarousable) to +4 (combative). 0 is a calm and responsive patient.

    Measured: Recorded at minute 1 and minute 30 of each three spontaneous Breathing Trial, 90 minutes

  26. Evolution of Borg dyspnea scale score

    Numeric scale to quantify dyspnea from 0 to 10. 0 mean patient does not feel that breathing is difficult and 10 is a maximal dyspnea.

    Measured twice during each Spontaneous Breathing Trial

    Measured: Recorded at minute 1 and minute 30 of each three spontaneous Breathing Trial, 90 minutes

  27. Evolution of Multidimensionnal dyspnea scale (MDP) score

    Score to quantify comfort, dyspnea and assess respiratory effort as perceived by patient. This scale contains multiple items, divided in two dimensions : sensory and affective.

    Sensory dimension contains : intensity on a scale of 0 to 10 of five sensory qualities (physical breathing effort, air hunger, tightness, mental breathing effort, hyperpnoea) Affective dimension contains : a breathing discomfort scale (scale of 0 to 10)

    Measured once during each Spontaneous Breathing Trial

    Measured: Recorded at minute 30 of each three spontaneous Breathing Trial, 90 minutes

Timeline

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

  1. First posted27 Feb 2019
  2. Study start8 Mar 2019
  3. Primary completion30 Jun 2023 (estimated)
  4. Study completion30 Dec 2023 (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
Other
Allocation
Randomised
Intervention model
Crossover
Model description
Three different spontaneous breathing trials modalities will be tested in each patient in a randomized order. Washout periods will be performed between the tested modalities.
Masking
None (open label)
Enrolment
18 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03856424
Sponsor's protocol ID
TWEEP
Acronym
TWEEP
Status last verified
May 2022
First submitted
28 Jan 2019
Last updated
3 Jun 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Modality 1, Modality 2 and Modality 3 in people with Mechanical Ventilation Complication, run by Piquilloud Imboden Lise at 1 site in Switzerland.

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 2 inclusion and 10 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 3 Jun 2022. 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 Switzerland. 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 Lise Piquilloud Imboden, MER&PD (+41 79 556 68 27, lise.piquilloud@chuv.ch), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Evolution of pressure-time product of esophageal pressure (time frame: Recorded every 5 minutes during each sequence and washout period, 180 minutes). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

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

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Jun 2022.

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