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NCT Number: NCT06662630

Physiological Effects and Safety of Continuous High-frequency Oscillatory Ventilation in Mechanical Ventilation Patients

Mechanical ventilation is an important treatment modality for intensive care unit (ICU) patients, but it also brings a series of problems such as ventilator-associated pneumonia, ventilator-induced lung injury, and atelectasis. Continuous High-Frequency Oscillation (CHFO )is often considered to have a protective effect on the lungs. CHFO provides effective gas exchange at supraphysiological frequencies while minimizing pressure fluctuations, producing tidal volumes smaller than dead space and adjusting around a continuously expanding pressure to optimize end-expiratory lung volume (EELV) by achieving and maintaining lung recruitment. However, the physiological effects and safety of CHFO in critically ill patients on mechanical ventilation lack relevant research. The objective of this research is to assess the feasibility, safety, and efficacy of CHFO in a population of mechanically ventilated critically ill patients.

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Key information

Conditions

Atelectasis Acute Respiratory Distress Syndrome Cross Infection Disease Attributes Healthcare-Associated Pneumonia Iatrogenic Disease Infections Lung Diseases Pathologic Processes Pathological Conditions, Signs and Symptoms Pneumonia Pneumonia, Ventilator-Associated Pulmonary Atelectasis Respiration Disorders Respiratory Distress Syndrome Respiratory Tract Diseases Respiratory Tract Infections VAP - Ventilator Associated Pneumonia

Age range

20 year–90 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Zhongshan Hospital, Fudan University

Shanghai, Shanghai Municipality, 200030, China

Location status: Recruiting

Location contact

Ming Zhong, PhD

CONTACT

[email protected]

02164001990 ext. 114

About this study

This is an interventional study evaluating the beneficial impact of CHFO of patients with mechanical ventilation on pathophysiological parameters.

This therapeutic study aims to treat patients using CHFO machine (MetaNeb system). The study consists of comparing pulmonary pathophysiological parameters before and after the treatment of CHFO in patients with invasive mechanical ventilation.

The primary outcome is the difference between the end-expiratory lung volume (EELV) and chest electrical impedance tomography (EIT) measured at the end of CHFO (10 min) and the basal value measured at the beginning of the protocol.

The minimum number of subjects to enroll in this study is 30 patients with invasive mechanical ventilation. Intermediate analyses are planned every 5 patients in order to reevaluate the needed number of patients.

The basal value at the beginning of the protocol, collection of ventilatory parameters on the ventilator, collection of arterial blood gas analyses and measurement of heart rate, and blood pressure. In the middle of treatment, collection of arterial blood gas analyses and measurement of heart rate, and blood pressure. At the end of the treatment, collection of ventilatory parameters on the ventilator, collection of arterial blood gas analyses and measurement of heart rate, and blood pressure.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients older than 18 and younger than 90 years;
  • Admitted to the ICU after October 15, 2024, who are intubated and expected to be unable to be extubated within 48 hours due to ARDS, or have atelectasis, or have VAP.
  • Signed informed consent for MetaNeb treatment.

Exclusion criteria

  • Refusal to participate in the proposed study.
  • Age < 20 years;
  • Pregnancy;
  • Significant hemodynamic instability defined as an increase of more than 20% in catecholamine doses in the last hour, despite optimization of blood volume, for a target mean blood pressure between 65 and 75 mmHg.
  • Participation in another trial within 30 days prior to meeting eligibility criteria;
  • Severe chronic respiratory disease requiring long-term oxygen therapy or home mechanical ventilation;
  • Pneumothorax;
  • Expected duration of mechanical ventilation < 48 hours
  • Decision to refuse life-sustaining treatment.

Treatment and study plan

High-Frequency Oscillatory Ventilation

Device

Administer 10 minutes of high-frequency oscillatory ventilation in mechanically ventilated patients.

Primary outcomes

  1. EELV

    Time frame: Baseline, and at the end of intervention (30th minute)

    EELV was measured utilizing the nitrogen washout-washin technique (E-sCOVX module sensor, GE Healthcare, Madison, WI, USA). The infusion of intravenous anesthetic agents and rocuronium bromide was administered to establish controlled mechanical ventilation during EELV measurement. Consistency in ventilator parameters was maintained throughout the EELV monitoring including follow-up measurements. Measurements will be taken at two time points: (1) Within 30 minutes before the start of CHFO and (2) within 30 minutes after its completion.

  2. EIT

    Time frame: Baseline, and at the end of intervention (30th minute)

    In EIT monitoring, a 16-electrode belt was placed around the chest to record signals. Measurements will be taken at two time points: (1) Within 30 minutes before the start of CHFO and (2) within 30 minutes after its completion.

Secondary outcomes

  1. Central venous pressure before and after the CHOF treatment

    Time frame: Baseline, and at the end of the intervention (30 minutes post-intervention)

    The CVC is inserted via the internal jugular vein, subclavian vein, or femoral vein, depending on the patient and their condition. CVP is measured using a pressure measurement system, according to the measurement requirements. Measurements will be taken at two time points: (1) Within 30 minutes before the start of CHFO and (2) within 30 minutes after its completion.

  2. PaO2/FiO2 ratio before and after the CHOF treatment

    Time frame: Baseline, and at the end of the intervention (30 minutes post-intervention)

    The PaO2/FiO2 ratio will be calculated by dividing the partial pressure of arterial oxygen (PaO2) by the fraction of inspired oxygen (FiO2). Measurements will be taken at two time points: (1) Within 30 minutes before the start of CHFO and (2) within 30 minutes after its completion.

  3. Plateau pressure

    Time frame: Baseline, and at the end of the intervention (30 minutes post-intervention)

    Measured during an end-inspiratory pause of 3 seconds.

  4. Mean arterial pressure

    Time frame: Baseline, during intervention, and at the end of intervention (30th minute)

    Mean arterial pressure measured continuously from the radial artery within 30 minutes before and after the treatment of CHOF and during the CHOF treatments.

  5. Adverse events

    Time frame: Baseline, during intervention, and at the end of intervention (30th minute)

    The occurrence of adverse events and the corresponding rate.

Study contacts

Contact information is provided by the study sponsor or research team.

Shengyu Hao, Ph.D

CONTACT

[email protected]

02164041990 ext. 13671

Yuxian Wang, B.S

CONTACT

[email protected]

02164041990

Sponsors and collaborators

Lead sponsor

Shanghai Zhongshan Hospital

Other

Registry information

Official study title

Assessing the Physiological Impact and Safety of Continuous High-Frequency Oscillatory Ventilation in Critically Ill Patients Under Mechanical Ventilation

Important dates

Study start
2024
Primary completion
2025
Study completion
2026
First posted
Oct 29, 2024
Registry last updated
Nov 20, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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