ART-3 Pilot - Driving Pressure Limited Ventilation for Patients Without ARDS (ART3pilot) (ART-3pilot)
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|ClinicalTrials.gov Identifier: NCT02376647|
Recruitment Status : Unknown
Verified February 2015 by Hospital do Coracao.
Recruitment status was: Not yet recruiting
First Posted : March 3, 2015
Last Update Posted : March 4, 2015
|Condition or disease||Intervention/treatment||Phase|
|Mechanical Ventilation Acute Respiratory Distress Syndrome||Other: Driving pressure limited ventilation Other: Conventional ventilation||Not Applicable|
Mechanical ventilation has the potential to produce or worsen alveolar injury. Driving pressure is the difference between plateau pressure and PEEP. Evidence from observational studies suggests that elevated driving pressure is the main independent determinant of ventilator-induced lung injury, however clinical trials are needed to establish whether targeting low driving pressures can improve clinical outcomes in patients without acute respiratory distress syndrome (ARDS).
Thus, ART-3 pilot is a multicenter randomized controlled trial to assess the feasibility of a driving pressure limited mechanical ventilation strategy compared to a conventional strategy in patients without ARDS. Patients considered to this trial are those in mechanical ventilation for less than 72 hours without diagnosis of ARDS. We will exclude patients with less than 18 years old; contraindication to hypercapnia such as intracranial hypertension or recent acute coronary syndrome; patients in which a high probability of death within 24 hours is anticipated and patients under exclusive palliative care. Eligible patients will be randomized to the driving pressure limited ventilation strategy or conventional strategy (tidal volume of 8 mL/kg of predicted body weight). The primary outcome is driving pressure between days 1 and 3.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||40 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||ART-3 Pilot: A Randomized Controlled Trial to Assess the Feasiblity of a Driving Pressure Limited Ventilation vs.Standard Strategy in Patients Without ARDS|
|Study Start Date :||March 2015|
|Estimated Primary Completion Date :||September 2015|
|Estimated Study Completion Date :||October 2015|
Experimental: Driving pressure limited ventilation
Driving pressure limited ventilation (≤13cmH2O)
Other: Driving pressure limited ventilation
Investigators will use volume controlled (or pressure support ventilation) and adjust tidal volume between 3 and 8 mL/Kg of predicted body weight in order to achieve a driving pressure of 13 cmH2O. The respiratory rate will be titrated to achieve a pH between 7.30 and 7.45 (maximum respiratory rate is 50 breathings per minute). Investigators will not limit plateau pressure in this arm.
Once a daily the investigators will assess the target tidal volume that generates a driving pressure of 13cmH2O. The patient should be sedated and without spontaneous efforts during this assessment.
Active Comparator: Conventional ventilation
Mechanical ventilation with limited tidal volume (8mL/kg of predicted body weight) and plateau pressure (≤30cmH2O)
Other: Conventional ventilation
Investigators will use volume controlled or pressure support ventilation, tidal volume ≤8 mL/kg of predicted body weight and plateau pressure limited to 30 cmH2O.The respiratory rate will be titrated to achieve a pH between 7.30 and 7.45 (maximum respiratory rate is 35 breathings per minute).
- Mean driving pressure between Day 1 and Day 3 [ Time Frame: From Day 1 to Day 3 after randomization ]
- Rate of investigators adering to study procedures [ Time Frame: Days 1 to 7 ]
- Rate of driving pressure equal or lower than 13 cmH2O [ Time Frame: Days 1 to 3 after randomization ]
- Mean of positive end expiratory pressure (PEEP) from day 1 to 7 [ Time Frame: Days 1 to 7 ]
- Mean tidal volume from day 1 to 7 [ Time Frame: Days 1 to 7 ]
- Mean static compliance of the respiratory system from day 1 to 7 [ Time Frame: Days 1 to 7 ]
- Mean plateau pressure from day 1 to 7 [ Time Frame: Days 1 to 7 ]
- Mean driving pressure from day 1 to 7 [ Time Frame: Days 1 to 7 ]
- Mean respiratory rate from day 1 to 7 [ Time Frame: Days 1 to 7 ]
- Number of patients with barotrauma [ Time Frame: Days 1 to 7 ]
- Mean of severe acidosis (pH <7.1) [ Time Frame: Days 1 to 7 ]
- Number of patients with other adverse events [ Time Frame: Days 1 to 7 ]
- Lenght of stay in intensive care unit [ Time Frame: Patients will be followed during the period of ICU stay, an expected average of 28 days ]
- Lenght of stay in hospital [ Time Frame: Patients will be followed during the period of hospital stay, an expected average of 28 days ]
- Number of mechanical ventilation free days from day 0 to day 28 [ Time Frame: From day 0 to day 28 ]
- ICU mortality [ Time Frame: Patients will be followed during the period of hospital stay, an expected average of 28 days ]
- In-hospital mortality [ Time Frame: Patients will be followed during the period of hospital stay, an expected average of 28 days ]
- 28-day survival [ Time Frame: From day 0 to day 28 ]
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02376647
|Contact: Alexandre B Cavalcanti, MD, PhD||+ 55 11 30536611 ext firstname.lastname@example.org|
|Contact: Lígia N Laranjeira||55 11 3053-6611 ext email@example.com|
|Study Chair:||Alexandre B Cavalcanti, MD, PhD||Hospital do Coração(Heart Hospital)|