ARDSnet Protocol vs. Open Lung Approach in ARDS

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Robert M. Kacmarek, Massachusetts General Hospital
ClinicalTrials.gov Identifier:
NCT00431158
First received: February 1, 2007
Last updated: September 17, 2014
Last verified: September 2014
  Purpose

Many patients with Acute Respiratory Distress Syndrome or ARDS need breathing support that is provided by a machine called a ventilator or respirator. The purpose of this study is to find out if a new method of setting the ventilator for patients with severe ARDS is better than the standard, commonly used way of setting the ventilator.


Condition Intervention
Respiratory Distress Syndrome, Adult
Other: Different Mechanical Ventilation Protocols

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: ARDSnet Protocol vs. the Open Lung Approach for the Ventilatory Management of Severe, Established ARDS: A Global Randomized Controlled Trial

Resource links provided by NLM:


Further study details as provided by Massachusetts General Hospital:

Primary Outcome Measures:
  • 60 day mortality [ Time Frame: 60 days ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • ICU mortality [ Time Frame: Duration of ICU stay ] [ Designated as safety issue: No ]
  • Hospital mortality [ Time Frame: Duration of hospital stay ] [ Designated as safety issue: No ]
  • 28 day mortality [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  • 180 day mortality [ Time Frame: 180 days ] [ Designated as safety issue: No ]
  • 365 day mortality [ Time Frame: 365 days ] [ Designated as safety issue: No ]
  • Ventilator free days [ Time Frame: Hospital stay ] [ Designated as safety issue: No ]
  • Length of ICU stay [ Time Frame: Duration of ICU stay ] [ Designated as safety issue: No ]
  • Development of extra-pulmonary organ failures [ Time Frame: Duration of hospital stay ] [ Designated as safety issue: No ]
  • Duration of hospitalization [ Time Frame: Duration of hospital stay ] [ Designated as safety issue: No ]
  • Incidence of barotrauma [ Time Frame: Duration of hospital stay ] [ Designated as safety issue: No ]
  • Systemic inflammatory mediator levels [ Time Frame: Duration of hospital stay ] [ Designated as safety issue: No ]
  • Lung function 6 months after discharge [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Lung function 12 months after discharge [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  • Need for rescue therapy [ Time Frame: Duration of hospital stay ] [ Designated as safety issue: No ]
  • Ventilation associated pneumonia rate [ Time Frame: Duration of hospital stay ] [ Designated as safety issue: No ]

Enrollment: 224
Study Start Date: January 2007
Study Completion Date: March 2013
Primary Completion Date: September 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1
ARDSnet Protocol
Other: Different Mechanical Ventilation Protocols

OLA Group: Open lung approach protocol and recruitment maneuvers

ARDSnet Group: ARDSnet protocol

Active Comparator: 2
OLA Protocol
Other: Different Mechanical Ventilation Protocols

OLA Group: Open lung approach protocol and recruitment maneuvers

ARDSnet Group: ARDSnet protocol


Detailed Description:

The ARDSnet protocol is the current, standard of care for ARDS. Mechanical ventilation is managed using low tidal volumes, relatively high respiratory rates, with oxygenation managed according to PEEP and FIO2 relationships as defined in a table. This study compares the ARDSnet protocol with an open lung approach to mechanical ventilation. The open lung approach uses a technique to recruit collapsed lung areas and then uses the lowest PEEP level that prevents recollapse of recruited lung units. The best PEEP level is determined by a decremental PEEP trial involving a series of pressure measurements taken after the recruitment maneuver. Both the ARDSnet protocol and the open lung approach require low tidal volumes and plateau pressures.

Evidence suggests that using a mechanical ventilation strategy of recruitment maneuvers (to open the collapsed lung) followed by high PEEP (to prevent collapse of the opened lung) with control of transpulmonary pressure through lower plateau pressures would maximize homogeneity within the lung and as such, minimize shearing forces in the lung parenchyma, thus improving ventilation and outcome in mechanically ventilated ARDS patients.

  Eligibility

Ages Eligible for Study:   18 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Intubated and mechanically ventilated
  • Diagnosis of ARDS using American-European consensus criteria
  • Enrollment in study < 48 hours since diagnosis of ARDS
  • For 12-36 hrs. (ideally 12-24 hrs) after diagnosis of ARDS, patient must be ventilated as follows: Volume A/C, Tidal volume of 4-8 ml/kg PBW, Plateau pressure ≤ 30 cmH2O, PEEP/FIO2 adjustments using ARDSnet table, Ventilator rate to keep PaCO2 = 35-60 mmHg
  • During the 12-36 hour(ideally 12-24 hr) period, PaO2/FIO2 must remain < 200 mm Hg for an ABG obtained 30 minutes after placement on the following specific ventilator settings: Volume A/C, Tidal volume = 6 ml/kg PBW, Plateau pressure ≤ 30 cmH2O, Inspiratory time ≤ 1 second, PEEP ≥ 10 cmH2O, FIO2 ≥ 0.5, Ventilator rate to keep PaCO2 = 35-60 mmHg
  • No lung recruitment maneuvers or adjunct therapy.
  • Total time on mechanical ventilation < 96 hrs. at time of randomization.

Exclusion Criteria:

  • Age < 18 years or > 80 years
  • Weight < 35 kg PBW
  • Body mass index > 60
  • Intubated 2° to acute exacerbation of a chronic pulmonary disease
  • Acute brain injury (ICP > 18 mmHg)
  • Immunosuppression 2° to chemo- or radiation therapy
  • Severe cardiac disease(one of the following): New York Heart Association Class 3 or 4, acute coronary syndrome or persistent ventricular tachyarrhythmias
  • Positive laboratory pregnancy test
  • Sickle cell disease
  • Neuromuscular disease
  • High risk of mortality within 3 months from cause other than ARDS, e.g. cancer
  • More than 2 organ failures (not including pulmonary system)
  • Documented lung barotrauma, i.e. chest tube placement other than for fluid drainage
  • Persistent hemodynamic instability or intractable shock
  • Penetrating chest trauma
  • Enrollment in another interventional study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00431158

Locations
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital
Investigators
Principal Investigator: Robert M Kacmarek, Ph.D., R.R.T Massachusetts General Hospital
  More Information

No publications provided

Responsible Party: Robert M. Kacmarek, Professor of Anesthesia, Director of Respiratory Care Services, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT00431158     History of Changes
Other Study ID Numbers: 2006-P-001878, BWH IRB Assurance #FWA00000484
Study First Received: February 1, 2007
Last Updated: September 17, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Massachusetts General Hospital:
Acute Respiratory Distress Syndrome
ARDS
Respiratory failure
Mechanical Ventilation
Positive end expiratory pressure
Lung recruitment maneuver

Additional relevant MeSH terms:
Syndrome
Respiratory Distress Syndrome, Newborn
Respiratory Distress Syndrome, Adult
Acute Lung Injury
Disease
Pathologic Processes
Lung Diseases
Respiratory Tract Diseases
Respiration Disorders
Infant, Premature, Diseases
Infant, Newborn, Diseases
Lung Injury

ClinicalTrials.gov processed this record on October 01, 2014