Individualised Weaning From Mechanical Ventilation in General ICU (iCareWean_CW)
|ClinicalTrials.gov Identifier: NCT03249623|
Recruitment Status : Unknown
Verified December 2017 by Chelsea and Westminster NHS Foundation Trust.
Recruitment status was: Recruiting
First Posted : August 15, 2017
Last Update Posted : December 13, 2017
Patients residing in the intensive care unit typically receive mechanical ventilatory support. Selecting the appropriate level of mechanical ventilation is not trivial, and it has been shown that lung protective settings can reduce mortality in patients with lung injury. Despite being a life- saving therapy, duration of mechanical ventilation should be kept at a minimum to reduce effects of immobilization, long-term sedation, patient discomfort, risk of ventilator associated pneumonia, leading to decreasing mortality and economic costs etc. The duration of mechanical ventilation is also an important factor in weaning from ventilatory support, with prolonged ventilator support making the weaning process more difficult.
The purpose of this study is to compare mechanical ventilation following advice from the Beacon Caresystem to that of standard care in general medical intensive care unit (ICU) patients, from the start of requiring invasive mechanical ventilation until successful extubation. The Beacon Caresystem will be compared to standard care to investigate whether use of the system results in similar care or reduced time for weaning from mechanical ventilation.
|Condition or disease||Intervention/treatment||Phase|
|Ventilatory Failure||Device: Beacon Caresystem||Not Applicable|
All patients admitted to the ICU with mechanical ventilation are screened for inclusion. Patients receiving invasive mechanical ventilation (≥ 24 h) will be considered for inclusion in the study on a daily basis. Patient screening will be performed by clinical researchers or a delegated clinician and consent/assent will be sought. Then patients will be randomised to the Beacon group or Standard Care group. Randomisation will be performed using sealed envelopes, and in blocks of patients, allowing interim analysis of results in appropriate steps during the study. To avoid that results are affected by patient disease type, randomisation will be stratified for equal distribution between randomisation groups.
Patients will be randomly assigned to either standard care of mechanical ventilation, or to follow the advice of the Beacon Caresystem. The results of these two strategies will then be compared based upon the following outcome measurements.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||274 participants|
|Intervention Model:||Sequential Assignment|
|Intervention Model Description:||After randomisation, for patients randomised in the Beacon group, the Beacon system will actively advice clinicians on ventilatory settings to adapt the ventilator to patient's individual clinical situation and corresponding clinical intervention.|
|Official Title:||Weaning From Mechanical Ventilation: Comparison of Open‐Loop Decision Support System and Routine Care, in the General Intensive Care Unit|
|Actual Study Start Date :||December 11, 2017|
|Estimated Primary Completion Date :||December 30, 2018|
|Estimated Study Completion Date :||August 30, 2019|
Experimental: Beacon Caresystem
On randomisation to the Beacon group, a Beacon Caresystem will be connected to the patient. This involves connecting a pulse oximeter to the patient's finger (toe or ear) to measure pulse oximetry oxygen saturation and pulse, and placing a standard clinical respiratory gas analysis and flow sensor in the respiratory tubing connecting the ventilator to the patient. This sensor allows measurement of respiratory pressure, flow and volume; plus respiratory gas CO2 and O2.
Device: Beacon Caresystem
The core of the system is a set of physiological models including pulmonary gas exchange, acid-base chemistry, lung mechanics, and respiratory drive. The Beacon Caresystem tunes these models to the individual patient such that they describe accurately current measurements. Once tuned, the models are used by the system to simulate the effects of changing ventilator settings. The results of these simulations are then used calculate the clinical benefit of changing ventilator settings by balancing the competing goals of mechanical ventilation.
No Intervention: Standard Care
For this group mechanical ventilation is managed according to standard care. A Beacon CareSystem will be connected to the patient, as for the Beacon Randomisation group, but the system will be used solely for data collection, and advice will be disabled. Physiological variables captured in this arm of the study will mirror the intervention arm. Decision relating to weaning, extubation, reintubation and sedation including level of seniority of personnel involved in the decision tree process will be documented accordingly.
- Length of mechanical ventilation [ Time Frame: Daily assessment of requirement of mechanical ventilation from the time of randomisation until the date of liberation from mechanical ventilation, up to 12 months. ]Length of mechanical ventilation, defined as either the time of intubation in the ICU, or the time of admission to the ICU following previous intubation for surgery, and until successful extubation, with successful
- Time to spontaneous ventilation [ Time Frame: Daily assessment of spontaneous ventilation from the date of randomisation until the date the patient starts breathing spontaneously, up to 12 months. ]It is defined as the time taken to wean from mandatory mode of ventilation
- Time to extubation [ Time Frame: Daily assessment of time to extubation from the date of initiation of spontaneous ventilation until the date of liberation from mechanical ventilation, up to 12 months. ]It is defined as the time the decision is made to proceed with removal of the endotracheal tube or tracheal decannulation.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03249623
|Contact: Damon P Foster||+44 2033156887 ext email@example.com|
|Contact: Stephen Rees, PhD||+45 firstname.lastname@example.org|
|The Magill Department of Anaesthesia, Chelsea and Westminster Hospital||Recruiting|
|London, United Kingdom, SW10 9NH|
|Contact: James R White, MBBS +447539729847 James.email@example.com|
|Contact: Margaret Smyth +447584640699 Margaret.firstname.lastname@example.org|
|Principal Investigator:||Marcela P Vizcaychipi, MD PhD FFICM||Chelsea and Westminster Hospital NHS Foundation Trust|