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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT02881814
Registration number
NCT02881814
Ethics application status
Date submitted
24/08/2016
Date registered
29/08/2016
Titles & IDs
Public title
UltraSound for Accurate Decisions in Chest PhysioTherapy
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Scientific title
Evaluation of the Impact of Lung and Diaphragm Ultrasound Findings on Clinical Decisions for Chest Physiotherapy in Patients Hospitalized in Intensive Care Units
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Secondary ID [1]
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US-ADEPT
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Universal Trial Number (UTN)
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Trial acronym
US-ADEPT
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Critical Illness
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Respiratory Disease
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Condition category
Condition code
Respiratory
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Other respiratory disorders / diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Diagnosis / Prognosis - Lung and diaphragm ultrasound
Diagnosis / Prognosis - Lung and diaphragm ultrasound in MV patients
Experimental: Lung ultrasound and clinical decision - Clinical assessment and choice of chest physiotherapy treatmetn performed by the clinical physiotherapist, followed by a comprehensive lung and diaphragm ultrasonography. After ultrasonography, the clinical physiotherapist is asked what CPT treatment he was going finally to implement, and explain the reasons for change, if any.
Experimental: Mechanically ventilated patients - In case of mechanically ventilated patient at St. Vincent Hospital (Sydney, Australia), LUS scan will be performed immediately following intubation. Additionnal LUS scans will be performed 72h after intubation and Immediately prior to or following extubation.
Diagnosis / Prognosis: Lung and diaphragm ultrasound
The ultrasound physiotherapist/operator performs a lung and diaphragm ultrasound. He is blinded to the patient's status and clinical physiotherapist examination. He/she is not involved in patient management or patient clinical decision-making. The ultrasound findings are recorded in the LUS report. The LUS report is reported to the clinical physiotherapist and to the intensivist. The ultrasound diagnosis(es) is recorded.
Diagnosis / Prognosis: Lung and diaphragm ultrasound in MV patients
In case of mechanically ventilated patient at St. Vincent Hospital (Sydney, Australia), LUS scan will be performed immediately following intubation. Additionnal LUS scans will be performed 72h after intubation and Immediately prior to or following extubation.
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Intervention code [1]
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Diagnosis / Prognosis
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Net Reclassification Index (NRI)
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Assessment method [1]
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Agreement (yes/no) between the lung and diaphragm US diagnosis and the clinical diagnosis and modification (yes/no) of the chest physiotherapy protocol
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Timepoint [1]
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Hour 1
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Secondary outcome [1]
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Prediction of duration of mechanical ventilation
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Assessment method [1]
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Number of days with mechanical ventialtion
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Timepoint [1]
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Final study visit
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Secondary outcome [2]
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Prediction of mortality
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Assessment method [2]
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Vital status at the end of ICU hospitalization
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Timepoint [2]
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Final study visit
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Eligibility
Key inclusion criteria
Inclusion criteria
* Hypoxemia(SpO2/FiO2< 315 (15))(indication for chest physiotherapy)(cf. annexe 1);
* Medical prescription for chest physiotherapy;
* First session of chest physiotherapy;
* Chest X-ray<12h available;
* Physiotherapist/operator qualified in LUS available;
* Patient's consent.
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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
Exclusion criteria
* Presence of a contra-indication for chest physiotherapy;
* Absence of hypoxemia;
* Absence of a prescription for chest physiotherapy;
* Absence of a chest X-ray < 12h from the time of physiotherapy assessment;
* Physiotherapist/operator qualified in LUS not available;
* Lung and diaphragm US not possible (surgical emphysema, dressing, scarring, drains etc.);
* Refusal of the patient or a relative to participate in the study;
* Patients to be discharged on the day of the study;
* Patients in palliative care;
* Withdrawal/limitations of medical care with impending death.
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Study design
Purpose of the study
Diagnosis
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
2/05/2017
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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
14/04/2024
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Actual
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Sample size
Target
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Accrual to date
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Final
153
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Recruitment in Australia
Recruitment state(s)
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Recruitment hospital [1]
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St Vincent's Hospital - Sydney
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Recruitment postcode(s) [1]
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NSW2010 - Sydney
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Recruitment outside Australia
Country [1]
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France
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State/province [1]
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Ile-de-France
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Country [2]
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France
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State/province [2]
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Dijon
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Country [3]
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France
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State/province [3]
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Férolles-Attilly
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Funding & Sponsors
Primary sponsor type
Other
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Name
Fondation Hôpital Saint-Joseph
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Hopital Forcilles
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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Centre Hospitalier Universitaire Dijon
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Address [2]
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Other collaborator category [3]
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Other
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Name [3]
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St Vincent's Hospital, Sydney
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Address [3]
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Ethics approval
Ethics application status
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Summary
Brief summary
Introduction: Physiotherapist usually uses a clinical examination, including auscultation, an analysis of blood gasses and chest imaging to determine the indication for chest physiotherapy, to choose the treatment protocol and evaluate the efficacy of the management. Lung ultrasound (LUS) presents greater accuracy than chest X-ray in the diagnosis of lung deficiencies interesting the physiotherapist. So, it could allow the physiotherapist to determine the indication for chest physiotherapy and thus avoid unnecessary or inappropriate treatments. No study has evaluated the impact of LUS on clinical decisions in chest physiotherapy in ICU patients. Objective: To evaluate the impact of using the results of lung and diaphragm US on clinical decisions in chest physiotherapy in hypoxemic patients hospitalized in ICU. Method: The physiotherapist carries out a clinical examination and analyses the complementary tests (chest X-ray, chest CT-scan and blood gasses if available). Following the examination, he will put forward one or several hypotheses concerning the respiratory deficiency and will confirm or not the indication for chest physiotherapy. If respiratory physiotherapy is indicated, the physiotherapist will specify the protocol. A lung and diaphragm US will be done following the evaluation of the clinical physiotherapist, and will make it possible to answer the question: are the results of the lung and diaphragm US compatible with the hypotheses put forward? The LUS report will be given to the clinical physiotherapist. He will specify the respiratory physiotherapy protocol according to the results of the US-scan. The modification of the clinical decision will be assessed with the Net Reclassification Index (NRI). Expected results: We expect that decisions for chest physiotherapy will be modified by LUS. The expected benefit for patients is therefore that they will be given a chest physiotherapy protocol that is better suited to the type of respiratory deficiency they are suffering from.
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Trial website
https://clinicaltrials.gov/study/NCT02881814
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Trial related presentations / publications
Xirouchaki N, Georgopoulos D. Impact of lung ultrasound on clinical decision making in critically ill patients: response to O'Connor et al. Intensive Care Med. 2014 Jul;40(7):1063. doi: 10.1007/s00134-014-3316-6. Epub 2014 May 6. No abstract available. Le Neindre A, Mongodi S, Philippart F, Bouhemad B. Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review. J Crit Care. 2016 Feb;31(1):101-9. doi: 10.1016/j.jcrc.2015.10.014. Epub 2015 Oct 26. Leech M, Bissett B, Kot M, Ntoumenopoulos G. Lung ultrasound for critical care physiotherapists: a narrative review. Physiother Res Int. 2015 Jun;20(2):69-76. doi: 10.1002/pri.1607. Epub 2014 Dec 29. Le Neindre A, Hansell L, Wormser J, Gomes Lopes A, Diaz Lopez C, Romanet C, Choukroun G, Nguyen M, Philippart F, Guinot PG, Buscher H, Bouhemad B, Ntoumenopoulos G. Thoracic ultrasound influences physiotherapist's clinical decision-making in respiratory management of critical care patients: a multicentre cohort study. Thorax. 2023 Feb;78(2):169-175. doi: 10.1136/thoraxjnl-2021-218217. Epub 2022 Mar 23.
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Public notes
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Contacts
Principal investigator
Name
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Belaid Bouhemad, MD, PhD
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Address
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Centre Hospitalier Universitaire Dijon
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Country
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Phone
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Fax
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Email
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Contact person for public queries
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
The data that support the findings of this study will be openly available in "figshare".
Supporting document/s available: Statistical analysis plan (SAP), Analytic code
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When will data be available (start and end dates)?
At publication.
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Available to whom?
The data that support the findings of this study will be openly available
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Available for what types of analyses?
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How or where can data be obtained?
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What supporting documents are/will be available?
No Supporting Document Provided
Type
Other Details
Attachment
Study protocol
Study Protocol, Statistical Analysis Plan, and Inf...
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https://cdn.clinicaltrials.gov/large-docs/14/NCT02881814/Prot_SAP_ICF_000.pdf
Statistical analysis plan
Study Protocol, Statistical Analysis Plan, and Inf...
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https://cdn.clinicaltrials.gov/large-docs/14/NCT02881814/Prot_SAP_ICF_000.pdf
Informed consent form
Study Protocol, Statistical Analysis Plan, and Inf...
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https://cdn.clinicaltrials.gov/large-docs/14/NCT02881814/Prot_SAP_ICF_000.pdf
Results publications and other study-related documents
Type
Citations or Other Details
Journal
Xirouchaki N, Georgopoulos D. Impact of lung ultra...
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Journal
Le Neindre A, Mongodi S, Philippart F, Bouhemad B....
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Journal
Leech M, Bissett B, Kot M, Ntoumenopoulos G. Lung ...
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Results not provided in
https://clinicaltrials.gov/study/NCT02881814