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Ventilator-associated Lung InjuryNCT06021249

Comparing Innovative and Traditional Ventilation Strategies on Atelectasis and Prognosis in Elderly Patients

A study testing Traditional ventilation strategies, Traditional lung-protective ventilation strategies and Innovative lung-protective ventilation strategies in people with Ventilator-associated Lung Injury and Atelectasis, run by Fujian Medical University Union Hospital at 3 sites in China.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

This study was divided into two parts, taking elderly patients undergoing general anesthesia surgery as the research subjects, through factorial design: 1. It was verified that in elderly patients undergoing general anesthesia surgery, innovative lung-protective ventilation strategies can reduce the occurrence of… Read more about this study

Who is it for?
Ages 60 to 100 years
What is being tested?
Traditional ventilation strategies, Traditional lung-protective ventilation strategies and Innovative lung-protective ventilation strategies
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
304 participants
Where
3 sitesChina
Study dates
28 Sep 2021to Jun 2024
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 60 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Elderly patients aged ≥ 60 years old who undergo laparoscopic abdominal surgery;
  • Body mass index(BMI) <30;
  • American society of anesthesiologists physical status classification system(ASA):I-III;
  • When the patient inhales air before surgery, SPO2≥94%;
  • The duration of the operation is 2-7 hours, and the pneumoperitoneal pressure is 10-14mmHg.

Who cannot join

  • Patients with acute respiratory distress syndrome or pulmonary hypertension (pulmonary systolic blood pressure ≥ 40mmHg) or bronchiectasis or lung malignant tumors
  • Patients with acute respiratory infections within one month before surgery
  • Patients who have undergone cardiopulmonary surgery
  • Receiving invasive mechanical ventilation for more than 30min within 30 days before surgery
  • Patients with peak airway pressure > 35 cm H2O during intraoperative mechanical ventilation
  • Patients with severe organic lesions of the heart such as obvious heart failure and coronary heart disease
Show all 13Show fewer
  • Patients with preoperative anemia (Hb<10g/L)
  • Patients with hypoproteinemia before surgery (albumin < 35 g/L)
  • Patients with tracheostomy and severe difficult airway
  • Patients with sleep apnea syndrome
  • Patients with intraoperative heavy bleeding (50% of the circulating blood volume is lost ≥ 3 hours)
  • Patients with mental illness, impaired consciousness and communication disorders
  • Patients who refuse to participate in this trial

Trial locations and contacts

3 sites in 1 country.

China3 sites, 3 recruiting
  • Fujian Medical University Union Hospital

    Fuzhou, Fujian

    Lingli Pan, +86 18065184976, panlin199104@163.com

    Recruiting
  • The First Affiliated Hospital of Nanchang University

    Nanchang, Jiangxi

    Jia Min, +86 13970899291, candymin66@163.com

    Recruiting
  • The First Hospital of Putian

    Putian, Fujian

    Huan Chen, +86 15080007150, flyupinsky@163.com

    Not yet recruiting

Other trials in China

About this study

Official title: Comparing the Effects of Innovative and Traditional Lung-protective Ventilation Strategies on the Occurrence of Perioperative Atelectasis and Prognosis in Elderly Patients: a Prospective, Randomized, Controlled Study

This study was divided into two parts, taking elderly patients undergoing general anesthesia surgery as the research subjects, through factorial design: 1. It was verified that in elderly patients undergoing general anesthesia surgery, innovative lung-protective ventilation strategies can reduce the occurrence of atelectasis and reduce the incidence of ventilator-related lung injury and postoperative pulmonary complications more than traditional lung-protective ventilation strategies; 2. On the basis of part one study proving that innovative lung-protective ventilation strategies can reduce the incidence of postoperative atelectasis and other complications in elderly patients undergoing general anesthesia surgery compared with traditional lung-protective ventilation strategies, further comparisons were made between the two factors of "positive pressure extubation" and "improved early postoperative respiratory training" in the innovative lung protective ventilation strategy, and whether there was an interaction between the two.

Read the detailed description

More and more people need to undergo general anesthesia surgery at least once in the lifetime, and patients who undergo general anesthesia surgery often have postoperative pulmonary complications, and the occurrence of postoperative pulmonary complications is related to the prolongation of the patient's hospital stay and postoperative mortality. This is contrary to the current goal of rapid postoperative recovery.

The International Expert Consensus on Strategies for Pulmonary Protective Ventilation states that age > 50 years is one of the greatest risk factors for postoperative pulmonary complications. This means that even older patients with largely unimpaired preoperative lung function are more likely to develop postoperative pulmonary complications than younger patients. Therefore, the investigators set the study to elderly patients undergoing general anesthesia surgery.

The traditional lung-protective ventilation strategies commonly used to reduce atelectasis and ventilator-related lung injury during general anesthesia surgery is controversial and mixed. Based on literature review and preliminary experiments, this study focuses on extubation and post-extubation, which is a critical period of atelectasis development, combines positive pressure extubation technology with improved postoperative early breathing training, replaces the controversial continuous positive airway pressure(CPAP)support and alveolar recruitment manoeuvres in traditional lung protective ventilation strategies, and explores a new respiratory management strategy with more operability and clinical effect to reduce complications such as postoperative atelectasis in elderly patients.

This study was originally a single-center clinical study and has been registered in the Chinese Clinical Trial Registry(Registration number:ChiCTR2300071364). It was later changed to a multi-center clinical study, so it was re-registered.

Being tested
Traditional ventilation strategies, Traditional lung-protective ventilation strategies, Innovative lung-protective ventilation strategies, Lung-protective ventilation, negative pressure extubation
Keywords
perioperative strategies for lung-protective ventilation, elderly patients, atelectasis, postoperative pulmonary complications, lung injury
Medical subject headings
Pulmonary Atelectasis, Lung Injury

What participants receive

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

  • Traditional ventilation strategiesProcedure or surgery

    1. Tidal volume:10ml/kg predicted body weight(PBW);
    2. 0 cm H2O positive end expiratory pressure(PEEP);
    3. negative pressure extubation
  • Traditional lung-protective ventilation strategiesProcedure or surgery

    1. Tidal volume:6ml/kg PBW;
    2. 5cmH2O PEEP;
    3. Ventilator-controlled recruitment manoeuvre;
    4. CPAP;
    5. negative pressure extubation
  • Innovative lung-protective ventilation strategiesProcedure or surgery

    1. Tidal volume:6ml/kg PBW;
    2. 5cmH2O PEEP;
    3. positive pressure extubation;
    4. postoperative breathing training
  • Lung-protective ventilationProcedure or surgery

    1. Tidal volume:6ml/kg PBW;
    2. 5cmH2O PEEP;
  • negative pressure extubationProcedure or surgery

    The suction tube is inserted into the endotracheal tube, continuous negative pressure suction, and at the same time that the balloon is completely deflated, the suction tube, dental pad and endotracheal intubation are pulled out at the same time, and then the patient is instructed to cough independently and remove sputum.

  • positive pressure extubationProcedure or surgery

    The adjustable pressure limiting(APL)was adjusted to 30cm H2O, and after the patient breathed spontaneously until the peak airway pressure reached 30cm H2O, and after maintaining this level for 10s, the balloon was quickly cut off to remove the endotracheal tube, so that the patient had an autonomous coughing action, and then the oral sputum was removed.

  • postoperative breathing trainingProcedure or surgery

    Inhale deeply through the nose, hold the breath for 5s, and then slowly spit out the breath through the mouth, cycle 5-6 times, and inflate the balloon. The above steps need to be performed 15 times within 24 hours after surgery.

Study groups in NCT06021249
Study groupRoleWhat they receive
Group of Control (Part I experiment)Sham comparatorTraditional ventilation strategies
Receives: Procedure: Traditional ventilation strategies
Group of traditional lung-protective ventilation (Part I experiment)ExperimentalTraditional lung-protective ventilation strategies
Receives: Procedure: Traditional lung-protective ventilation strategies
Group of innovative lung-protective ventilation (Part I experiment)ExperimentalInnovative lung-protective ventilation strategies
Receives: Procedure: Innovative lung-protective ventilation strategies
Group of traditional & innovative ventilation (Part I experiment)ExperimentalTraditional \& innovative lung protection ventilation strategies
Receives: Procedure: Traditional lung-protective ventilation strategies; Procedure: Innovative lung-protective ventilation strategies
Group of Control (Part II experiment)Sham comparator1. lung-protective ventilation; 2. negative pressure extubation
Receives: Procedure: Lung-protective ventilation; Procedure: negative pressure extubation
Group of positive pressure extubation (Part II experiment)Experimental1. lung-protective ventilation; 2. positive pressure extubation
Receives: Procedure: Lung-protective ventilation; Procedure: positive pressure extubation
Group of breathing training (Part II experiment)Experimental1. lung-protective ventilation; 2. negative pressure extubation; 3. postoperative breathing training
Receives: Procedure: Lung-protective ventilation; Procedure: negative pressure extubation; Procedure: postoperative breathing training
Group of positive pressure extubation & breathing training (Part II experiment)Experimental1. lung-protective ventilation; 2. positive pressure extubation; 3. postoperative breathing training
Receives: Procedure: Lung-protective ventilation; Procedure: positive pressure extubation; Procedure: postoperative breathing training

What is being measured

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

  1. Volume ratio of new-onset atelectasis after surgery

    After lung CT examination, the postoperative volume ratio of new atelectasis (new atelectasis volume/total lung volume) was calculated.

    Measured: Pre-surgery;Approximately 24 hours after surgery

Secondary outcomes (3)
  1. postoperative pulmonary complications

    Diagnosis according to the US Centers for Disease Control definition of pneumonia:

    Two or more serial chest radiographs with at least one of the following (one radiograph is sufficient for patients with no underlying pulmonary or cardiac disease):

    (i) New or progressive and persistent infiltrates, (ii)consolidation, (iii) cavitation;

    AND at least one of the following:

    1. fever (>38°C) with no other recognised cause,
    2. leucopaenia (white cell count <4*10^9/ litre) or leucocytosis(white cell count >12*10^9 /litre),
    3. for adults >70 years old, altered mental status with no other recognised cause;

    AND at least two of the following:

    1. new onset of purulent sputum or change in character of sputum, or increased respiratory secretions, or increased suctioning requirements,
    2. new onset or worsening cough, or dyspnoea, or tachypnoea,
    3. rales or bronchial breath sounds,
    4. worsening gas exchange (hypoxaemia, increased oxygen requirement, increased ventilator demand).

    Measured: Within 14 days after surgery; Within 30 days after surgery

  2. specific indexes of ventilator-related lung injury

    Blood was drawn and centrifuged for serum ELISA to detect landmark indicators of ventilator-related lung injury

    Measured: Pre-surgery;Immediately after the extubation;Approximately 24 hours after surgery

  3. oxygenation index

    Arterial blood samples are drawn for blood gas analysis

    Measured: Pre-surgery;20 minutes after the intubation;End of the operation;Approximately 10 minutes after the extubation;Approximately 40 minutes after the extubation;Approximately 70 minutes after the extubation;Approximately 24 hours after surgery

Timeline

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

  1. First posted1 Sep 2023
  2. Study start28 Sep 2021
  3. Primary completionDec 2023 (estimated)
  4. Study completionJun 2024 (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
Prevention
Allocation
Randomised
Intervention model
Factorial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
304 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06021249
Sponsor's protocol ID
2021MZK04KY
Status last verified
Aug 2023
First submitted
2 Aug 2023
Last updated
1 Sep 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: In June 2024, raw data was shared through ResMan(http://www.medresman.org.cn/login.aspx)

Questions about this trial

What is this clinical trial studying?

A study testing Traditional ventilation strategies, Traditional lung-protective ventilation strategies and Innovative lung-protective ventilation strategies in people with Ventilator-associated Lung Injury and Atelectasis, run by Fujian Medical University Union Hospital at 3 sites in China.

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 13 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 1 Sep 2023. 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 China. 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. Some participants in this study may receive a placebo. 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 Lingli Pan (+86 18065184976, panlin199104@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Volume ratio of new-onset atelectasis after surgery (time frame: Pre-surgery;Approximately 24 hours after surgery). 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 1 Sep 2023.

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