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Trial registered on ANZCTR
Registration number
ACTRN12616000530426
Ethics application status
Approved
Date submitted
13/02/2016
Date registered
22/04/2016
Date last updated
27/03/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Ultrasonography of respiratory muscles to estimate the probability of extubation failure after cardiothoracic surgery
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Scientific title
Can extubation failure after cardiothoracic surgery be predicted by echography of the diaphragm muscles?
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Secondary ID [1]
288531
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None
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Universal Trial Number (UTN)
U1111-1180-1999
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Trial acronym
EXPEDIA Study: EXtubation failure Prediction by Echography of the DIAphragm
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
acute respiratory failure
297627
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Condition category
Condition code
Respiratory
297812
297812
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0
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Other respiratory disorders / diseases
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Surgery
297813
297813
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0
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Other surgery
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Intervention/exposure
Study type
Observational
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Patient registry
True
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Target follow-up duration
2
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Target follow-up type
Days
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Description of intervention(s) / exposure
Occurrence of acute respiratory failure during weaning process defined as:
- Failure of a spontaneous breathing trial
- Post extubation acute respiratory failure
Duration of observation will be 2 days if extubation occurs
Diaphragm thickness (tdi) will be measured in the zone of apposition of the diaphragm to the rib cage using a 10-MHz linear ultrasound probe. Diaphragm thickening fraction (TFdi) will be defined as the percentage change in tdi between end-expiration and end-inspiration. Those index will be calculated in each patients during ventilation with pressure support (PS) and during SBT on the right and left sides. Ultrasound performed 10 minutes after beginning of PS and 10 minutes after beginning of SBTWeaning failures will be defined by reintubation within 48 hours post extubation or failure of the SBT.
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Intervention code [1]
293905
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Diagnosis / Prognosis
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
297338
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Diaphragm thickening fraction using a 10-MHz linear ultrasound probe.
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Assessment method [1]
297338
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Timepoint [1]
297338
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At the end of a spontaneous breathing trial
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Primary outcome [2]
297339
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Extubation failure defined as
failure of a spontaneous breathing trial or a respiratory failure occuring during the next 48 hours following extubation
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Assessment method [2]
297339
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Timepoint [2]
297339
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end of a spontaneous breathing trial and during the 48 hours after extubation.
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Secondary outcome [1]
320760
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Change in diaphragm thickening fraction between breathing during pressure support and SBT, assessed by 10-MHz linear ultrasound probe
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Assessment method [1]
320760
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Timepoint [1]
320760
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end of the pressure support
end of the spontaneous breathing trial
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Eligibility
Key inclusion criteria
Adult patients after cardiothoracic surgery under mechanical ventilation and eligible to weaning process according to the attending physician
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Minimum age
18
Years
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Maximum age
No limit
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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
diaphragmatic palsy
pregnant women
patient's refusal
infants and youngs
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Study design
Purpose
Screening
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Duration
Cross-sectional
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Selection
Convenience sample
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Timing
Prospective
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Statistical methods / analysis
Normality of data distribution will be assessed using the Kolmogorov-Smirnov test. Continuous variables will be described as mean (SD) or median [interquartile range (IQR)] and compared using Student's t test or the Mann-Whitney U test, as appropriate. The chi-square test or Fisher’s exact test are chosen to compare categorical variables. Sensitivity (Se), specificity (Sp), and predictive values were computed using standard formulas. A P value <0.05 was considered significant.
After a preliminary study, we evaluated that a 30% increase of diaphragm thickening fraction led to a sensitivity of 100% and a specificity of 84% for extubation failure. Therefore, for a sensitivity with a 95%-condidence interval=90%-100%, we need to evaluate 5 patients with extubation failure. For a specificity with a 95%-condidence interval=77%-97%, we need to evaluate 43 patients with extubation success.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
2/05/2016
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Actual
2/05/2016
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Date of last participant enrolment
Anticipated
28/10/2016
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Actual
25/11/2016
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Date of last data collection
Anticipated
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Actual
27/11/2016
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Sample size
Target
48
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Accrual to date
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Final
53
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Recruitment outside Australia
Country [1]
7588
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France
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State/province [1]
7588
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Funding & Sponsors
Funding source category [1]
292878
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Hospital
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Name [1]
292878
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Hopital Marie Lannelongue
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Address [1]
292878
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133 avenue de la Resistance
92350 Le Plessis robinson
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Country [1]
292878
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France
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Primary sponsor type
Hospital
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Name
Hopital Marie Lannelongue
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Address
133 avenue de la Resistance 92350 Le Plessis robinson
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Country
France
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Secondary sponsor category [1]
291621
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None
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Name [1]
291621
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None
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Address [1]
291621
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None
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Country [1]
291621
0
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
294382
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Comite de Protection des Personnes Ile de France VII
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Ethics committee address [1]
294382
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Hopital de Bicetre 78 rue du General Leclerc 94275 Le Kremlin
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Ethics committee country [1]
294382
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France
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Date submitted for ethics approval [1]
294382
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06/11/2013
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Approval date [1]
294382
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11/12/2013
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Ethics approval number [1]
294382
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2013-A01552
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Summary
Brief summary
The failure of weaning from mechanical ventilation can be associated with a diaphragmatic dysfunction after thoracic cardiovascular surgery. Ultrasound measurements of diaphragm tickening may be useful to monitor diaphragm activity of each half diaphragm. We expect to establish a sonographic criteria during the spontaneous breathing trial (SBT) to predict weaning failure from mechanical ventilation after cardio thoracic surgery. Patients after majors cardio or thoracic surgery who met criteria for a spontaneous breathing trial will be enrolled. All patients with a half diaphragm paralyzed will be excluded. Diaphragm thickness (tdi) will be measured in the zone of apposition of the diaphragm to the rib cage using a 10-MHz linear ultrasound probe. Diaphragm thickening fraction (TFdi) will be defined as the percentage change in tdi between end-expiration and end-inspiration. Those index will be calculated in each patients during ventilation with pressure support (PS) and during SBT on the right and left sides. Weaning failures will be defined by reintubation within 48 hours post extubation or failure of the SBT. We have planne to enrolled prospectively 48 patients. We will evaluate the sensitivity and specificity of diaphragm thickening fraction to predict SBT or extubation failure. The area under the receiver operating characteristic curve will be calculated. We expected to show that ultrasound measures of diaphragm thickening may be useful to predict extubation success or failure.
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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
63518
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Prof STEPHAN Francois
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Address
63518
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Reanimation adulte
Hopital Marie Lannelongue
133 avenue de la Resistance
92350 Le Plessis Robinson
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Country
63518
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France
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Phone
63518
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+33 1 40 94 85 80
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Fax
63518
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+ 33 1 40 94 85 86
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Email
63518
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[email protected]
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Contact person for public queries
Name
63519
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STEPHAN Francois
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Address
63519
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Reanimation adulte
Hopital Marie Lannelongue
133 avenue de la Resistance
92350 Le Plessis Robinson
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Country
63519
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France
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Phone
63519
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+33 1 40 94 85 80
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Fax
63519
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+33 1 40 94 85 86
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Email
63519
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[email protected]
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Contact person for scientific queries
Name
63520
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STEPHAN Francois
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Address
63520
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Reanimation adulte
Hopital Marie Lannelongue
133 avenue de la Resistance
92350 Le Plessis Robinson
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Country
63520
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France
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Phone
63520
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+33 1 40 94 85 80
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Fax
63520
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+33 1 40 94 85 86
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Email
63520
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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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