Evaluation of a Mechanical Device During Acute Respiratory Failure in Patients With Neuromuscular Disorders (Nemucough)
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Purpose
The hypothesis is that a mechanical insufflation-exsufflation (MI-E) is associated with a decrease in the number of intubations and more rapid clinical improvement in children and adults with neuromuscular disease who are admitted for an acute respiratory exacerbation.In this prospective, randomised, multicenter study, 55 patients will be treated with standard treatment and a MI-E, and 55 patients with standard treatment and standard respiratory physiotherapy. The primary objective is the reduction of the number of patients requiring invasive ventilatory support (endotracheal intubation or tracheotomy) in the group treated with MI-E (MI-E group). The main secondary objectives are a reduction in hospital stay and an improvement in clinical condition, dyspnea and respiratory muscle function.
| Condition | Intervention | Phase |
|---|---|---|
|
Duchenne Muscular Dystrophy Amyotrophic Lateral Sclerosis Neuromuscular Diseases |
Device: mechanical insufflation - exsufflation Device: Standard respiratory physiotherapy |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Evaluation of a Mechanical Insufflation-exsufflation Device During Acute Respiratory Failure in Patients With Neuromuscular Disorders: a Prospective, Randomized, Controlled, Multicenter Study |
- Reduction of the number of patients requiring invasive ventilatory support in the group treated with MI-E (MI-E group) compared to the group treated with traditional chest physiotherapy without MI-E (Control group). [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
- Decrease in the length of hospitalization in the intensive care unit (ICU) (if necessary) [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
- Decrease in the total length of hospitalization [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
- Decrease in the incidence of bronchoscopy-assisted aspiration [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
- Decrease in the duration of oxygen therapy [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
- Decrease in the daily length of noninvasive positive pressure ventilation (NPPV) [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
- Improvement in blood gases on room air during hospitalization and improvement of the peak cough flow (PCF) [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
- Improvement of the vital capacity (VC), maximal inspiratory (PImax) and expiratory (PEmax) pressures, sniff nasal inspiratory pressure (SNIP), peak expiratory flow (PEF) and dyspnea during hospitalization [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
- Decrease in the number of secondary tracheotomies (for weaning of ventilatory support) [ Time Frame: During the treatment phase ] [ Designated as safety issue: No ]
| Enrollment: | 14 |
| Study Start Date: | June 2009 |
| Estimated Study Completion Date: | December 2011 |
| Primary Completion Date: | February 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: 1
patients treated with standard treatment and a mechanical insufflation-exsufflation
|
Device: mechanical insufflation - exsufflation
Patients will receive MI-E treatment with the following settings: insufflation pressure of at least +30 cm H2O and an exsufflation pressure ≥ -30 cm H2O. There will be at least 6 hyperinflation/exsufflation sequences per session of chest physiotherapy. There will be at least two daily sessions done routinely by the respiratory therapist at 8 hour intervals.
Other Name: Mechanical insufflation-exsufflation devices assist cough
|
|
Active Comparator: 2
Patients with standard treatment and standard respiratory physiotherapy
|
Device: Standard respiratory physiotherapy
Traditional chest physiotherapy without mechanical insufflation-exsufflation
Other Name: Standard respiratory physiotherapy
|
Detailed Description:
Justification Respiratory muscle weakness reduces the efficacy of the cough reflex in patients with neuromuscular disorders and exposes them to the risk of acute respiratory failure. Mechanical insufflation-exsufflation devices assist cough and have been shown to be efficient in increasing the cough expiratory flow in children and adults with neuromuscular disease and decreasing the risk of intubation in a limited population of hospitalized adults with acute respiratory failure.
Primary objective The goal is to record the efficacy of mechanical insufflation-exsufflation (MI-E) during acute respiratory failure in patients with neuromuscular disorders.The primary objective is the reduction of the number of patients requiring invasive ventilatory support (endotracheal intubation or tracheotomy) in the group treated with MI-E (MI-E group) compared to the group treated with traditional chest physiotherapy without MI-E (Control group).
Secondary objectives
In the MI-E group, compared to the Control group:
- Decrease in the length of hospitalization in the intensive care unit (ICU)
- Decrease in the total length of hospitalization
- Decrease in the incidence of bronchoscopy-assisted aspiration
- Decrease in the duration of oxygen therapy
- Decrease in the daily length of noninvasive positive pressure ventilation (NPPV)
- Improvement in blood gases on room air during hospitalization
- Improvement of the peak cough flow (PCF)
- Improvement of the vital capacity (VC), maximal inspiratory (PImax) and expiratory (PEmax) pressures, sniff nasal inspiratory pressure (SNIP), peak expiratory flow (PEF) and dyspnea during hospitalization.
- Decrease in the number of secondary tracheotomies (for weaning of ventilatory support)
Type of study Prospective, randomized, controlled, multicenter study
Number of subjects The calculation of the number of subjects is based on two retrospective studies. In the study by VIANELLO, which included 11 adults hospitalized in the ICU for respiratory failure, the number of therapeutic failures, defined as the need for a "mini" tracheotomy or intubation, was significantly less in the group using MI-E than in a group of 16 historical control patients [2 failures in the MI-E group (18%) versus 10 failures in the control group (63%), p<0.05] (1). Another study reported 19 successes (80%) versus 5 failures on MI-E (2).
Eligibility| Ages Eligible for Study: | 4 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Pediatric or adult patients with chronic neuromuscular disorders, such as spinal muscular atrophy, Duchenne muscular dystrophy, other congenital myopathy, or amyotrophic lateral sclerosis (ALS), hospitalized for acute respiratory failure, as defined by:
- Persistent bronchial encumbrance (> 2 days) despite regular treatment in the homecare setting, associated with-Oxygen desaturation on room air, defined by a pulse oximetry (SaO2) <95%) or
- In patients not receiving long-term NPPV: the need to institute NPPV-In patients receiving long-term NPPV: the need to increase the daily length of NPPV by at least 25%.
Exclusion Criteria:
- Need for immediate intubation (alteration in consciousness, coma, hemodynamic disorders)
- Multiple organ failure (e.g., associated cardiac failure)
- In adults: respiratory rate >30/min, pH < 7.35, PaCO2 > 50 mm Hg
- Facial deformity or anomaly which prevents the use of a mouthpiece or mask
- Patients who signed a refusal to be intubated regardless of the progression of their disease
- Patients on long-term oxygen therapy
- Tracheotomized patients
- Patients requiring the use of an intrapulmonary percussive ventilation device during hospitalization
- Acute neuromuscular disorder of known or unknown etiology
- Associated lung disease such as chronic obstructive pulmonary disease (COPD)
- Refusal of patient consent and/or parental consent in the case of a minor
- Uncooperative patients
- Patients < 4 years old
Contacts and Locations| France | |
| Hospital Armand Trousseau, Pediatric Pulmonology Department and INSERM UMR S-893 | |
| Paris, France, 75012 | |
| Principal Investigator: | Brigitte FAUROUX, MD PhD | Assistance Publique - Hôpitaux de Paris |
More Information
No publications provided
| Responsible Party: | Assistance Publique - Hôpitaux de Paris |
| ClinicalTrials.gov Identifier: | NCT00839033 History of Changes |
| Other Study ID Numbers: | P080406 |
| Study First Received: | February 6, 2009 |
| Last Updated: | December 26, 2011 |
| Health Authority: | France: Ministry of Health |
Keywords provided by Assistance Publique - Hôpitaux de Paris:
|
Cough assisted device Neuromuscular disease Respiratory exacerbation |
Invasive ventilation, Chest physiotherapy Congenital myopathies |
Additional relevant MeSH terms:
|
Amyotrophic Lateral Sclerosis Muscular Dystrophy, Duchenne Muscular Dystrophies Neuromuscular Diseases Sclerosis Motor Neuron Disease Respiratory Distress Syndrome, Adult Respiratory Insufficiency Spinal Cord Diseases Central Nervous System Diseases Nervous System Diseases Neurodegenerative Diseases |
TDP-43 Proteinopathies Proteostasis Deficiencies Metabolic Diseases Muscular Disorders, Atrophic Muscular Diseases Musculoskeletal Diseases Genetic Diseases, X-Linked Genetic Diseases, Inborn Pathologic Processes Lung Diseases Respiratory Tract Diseases Respiration Disorders |
ClinicalTrials.gov processed this record on May 16, 2013