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Trial registered on ANZCTR
Registration number
ACTRN12611000304932
Ethics application status
Not yet submitted
Date submitted
18/03/2011
Date registered
22/03/2011
Date last updated
22/03/2011
Type of registration
Prospectively registered
Titles & IDs
Public title
Detection, quantification and differentiation of upper and lower airway obstruction during mechanical ventilation
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Scientific title
Detection of upper and lower airway obstruction in patients with normal lungs and chronic obstructive airways disease and asthma while being mechanically ventilated
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Secondary ID [1]
259816
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Lung Disease
COAD
Asthma
265397
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Condition category
Condition code
Respiratory
265553
265553
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0
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Other respiratory disorders / diseases
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Intervention/exposure
Study type
Observational
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Patient registry
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Observation of airways resistance in patients that are mechanically ventilated.
Two groups of patients will be selected, patients with normal lungs and patients with lower airway obstruction(COAD and asthma)
Each patient will be placed on controlled mechanical ventilation, in SIMV and progressively smaller diameter endotracheal tubes will be inserted into the existing endotracheal tube for a period of less than one minute.
Measurements of flow and volume and determination of resistance will be determined.
The patients will have these measurements done within an hour.
The patients will be recruited when they are in intensive care. The recruitment will therefore not be planned. Only when patients are deemed suitable candidates by their existing ventilation will a relative be contacted for consent purposes.
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Intervention code [1]
264257
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Not applicable
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Comparator / control treatment
Patients with normal lungs
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Control group
Active
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Outcomes
Primary outcome [1]
262359
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Determination of airway resistances by analysis of the flow and volume pressure curves from a ventilator. These flow and volumes will be measured after insertion of three progressively decreasing sized endotracheal tubes into already existing endotracheal tubes in an unconscious mechanically ventilated patient.
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Assessment method [1]
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Timepoint [1]
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Immediately after decreasing airway resistance for less than one minute.
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Secondary outcome [1]
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The above measurements will be analysed to determine the best marker for upper and lower airway resistances.
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Assessment method [1]
273624
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Timepoint [1]
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Analysis after ventilatory waveform data has been recorded.
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Eligibility
Key inclusion criteria
Unconscious patients intubated and mechanically ventilated in intensive care.
1 group with normal lungs and 1 group with Chronic obstructive airways disease or asthma
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Minimum age
18
Years
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Maximum age
99
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Patients not under mechanical ventilation in the intensive care environment
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Study design
Purpose
Screening
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
10/04/2011
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
40
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
264697
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Hospital
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Name [1]
264697
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Intensive care department
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Address [1]
264697
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The Alfred Hospital
Commercial Road Prahran Victoria 3181
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Country [1]
264697
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Australia
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Primary sponsor type
Hospital
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Name
Intensive care department
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Address
The Alfred Hospital
Commercial Road Prahran Victoria 3181
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Country
Australia
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Secondary sponsor category [1]
263831
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None
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Name [1]
263831
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Address [1]
263831
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Country [1]
263831
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
266691
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Research and Ethics Unit
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Ethics committee address [1]
266691
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The Alfred Hospital Commercial Road Prahran 3181 Victoria
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Ethics committee country [1]
266691
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Australia
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Date submitted for ethics approval [1]
266691
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15/03/2011
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Approval date [1]
266691
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Ethics approval number [1]
266691
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Summary
Brief summary
During mechanical ventilation, increased upper airway resistance may be due to a partial obstruction of the artificial airway or a large airway abnormality. Increased lower airway resistance is usually due to acute or chronic airways disease. Either of these problems can lead to increased work of breathing, uncoordinated ventilator support, respiratory distress and difficulty weaning. Recognition of these problems can lead to important interventions such as bronchoscopy, artificial airway change or reposition, bronchodilator therapy and change of ventilation strategy that can improve patient distress and safety. Quantification of these variables can allow assessment of severity and the response to intervention. Our hypotheses are that 1. the most valuable variable for quantifying reduced expiratory airflow will be the passive expiratory volume expired during the first second of expiration PEV1 expressed as a percentage of the Vt (PEV1/Vt ratio). This is similar to the well recognised standard of FEV1/VC ratio from spirometric quantification of (lower) airflow obstruction. 2. the most valuable variable for quantifying increased inspiratory resistance during VCV with decelerating inspiratory flow or during PCV will be the difference between the Paw and calculated Palv during early inspiration divided by the inspiratory flow at that time. 3. Upper airway obstruction will be distinguished from and lower airway obstruction by a higher inspiratory resistance relative expiratory resistance We propose to examine these hypotheses in patients with normal lungs with added inspiratory resistances and in patients with lower airway obstruction (COAD or asthma) to show whether measurements of flow and volume are independent of or can account for ventilator pattern (flow rate, flow pattern, tidal volume) and can recognise and quantify both increasing resistances in large (upper) airways and lower airway obstruction to distinguish between them. Methods Two patient groups will be selected based on the following lung pathology 1. Normal Lungs: 20 mechanically ventilated patients with no significant underlying lung disease and no significant lung injury will be selected. Each will be studied to provide a normal values of the resistance measurements. Then each will be given a series of 3 upper airway resistances for a period of less than a minute to mimic large airway obstruction (similar to a partially blocked endo-tracheal or tracheostomy tube). This will be achieved by placing a 10 cm sterilized flexible tube in the endo-tracheal or tracheostomy tube to simulate a residual diameter equivalent to an ETT size (internal diameter) 6, 4.5 and 3 mm. This is little different to and carries no more risk than routine patient suctioning where the artificial airway is partly occluded to a similar degree for a short time 2. Lower airway obstruction (COPD, Asthma): 20 mechanically ventilated patients with known obstructive airways disease (lower airway obstruction) Each patient group will be placed in controlled mechanical ventilation and given the same series of ventilatory patterns to determine the reliability of the measurements of inspiratory and expiratory resistance measurements under different ventilatory conditions
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
32360
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Address
32360
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Country
32360
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Phone
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Fax
32360
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Email
32360
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Contact person for public queries
Name
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David Tuxen
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Address
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Intensive Care , The Alfred, Commercial Rd Prahran,
3181
Victoria
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Country
15607
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Australia
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Phone
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+61 3 90763036
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Fax
15607
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+61 2 90763780
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Email
15607
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[email protected]
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Contact person for scientific queries
Name
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David Tuxen
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Address
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Intensive Care , The Alfred, Commercial Rd Prahran, Victoria
3181
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Country
6535
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Australia
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Phone
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+61 3 90763036
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Fax
6535
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+61 3 90763780
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Email
6535
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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