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DAMP-Mediated Innate Immune Failure and Pneumonia After Trauma - the Harvard-Longwood (HALO) Campus Area Consortium (HALO)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03993002
Recruitment Status : Suspended (Enrollment has temporarily paused due to COVID-19 and is expected to resume in the future; This is not a suspension of IRB approval)
First Posted : June 20, 2019
Last Update Posted : April 28, 2020
Sponsor:
Collaborator:
United States Department of Defense
Information provided by (Responsible Party):
Beth Israel Deaconess Medical Center

Brief Summary:

The mortality burden of trauma in the United States is substantial, and is currently the leading cause of death in warfare and in civilians below age 45. Infection and sepsis are leading causes of morbidity and death in early survivors. Pneumonia (PNA) occurs in 17-36% of ventilated trauma patients; far more than non-trauma patients. The long held dogmatic notion of a mechanical predisposition to development of pneumonia in trauma has lacked robust support. However, there is evidence of the innate immune response to injury plays a major role in increasing susceptibility to infection.

This application is for support of a Focused Program Award addressing the role that "danger signaling" due to "danger associated molecular patterns" (or DAMPs) derived from somatic tissue injuries play in altering innate immune signaling in the lung in ways that predisposes to PNA. This innate immune response plays a pivotal role in the development and progression of lung inflammation. The organization of the Focused Program Award is into six Projects with collaborators from the Departments of Surgery, Medicine and Anesthesiology at Beth Israel Deaconess Medical Center; the Department of Surgery at Brigham and Women's Hospital and the Departments of Biology and Biological Engineering at Massachusetts Institute of Technology.

The human subjects interaction portion of this project is covered in the Human Subjects & Samples Project of the Award, although the information and tissues obtained from this Project will be shared with the other Projects, and the activities planned for those Projects are outlined in this application.


Condition or disease Intervention/treatment Phase
Respiratory Failure Other: Normoxia with Normocarbia Other: Normoxia with Hypercarbia Other: Hyperoxia with Normocarbia Other: Hyperoxia with Hypercarbia Not Applicable

Detailed Description:
The purpose of the interventional group is to address Aim 3 of this research study. Aim 3 will be accomplished by randomizing eligible patients to normoxic or hyperoxic conditions with normocarbic or hypercarbic blood concentrations through ventilator adjustments per the factorial design. All four groups are considered within the bounds of standard practice for many mechanically ventilated patients. Investigators will exclude patients in whom these settings could be detrimental. The patient will be on the study settings by hour 60 of mechanical ventilation, and these settings will be held for 48 hours from achieving the target partial pressure of oxygen (PaO2) levels. Upon enrollment, an arterial line will be placed if there is not already one in place, and an arterial blood gas (ABG) will be drawn if no ABG has been drawn in the prior 12 hours to enrollment. Over 1-3 hours following ventilator adjustments, several ABGs will be drawn in order to determine the need for additional ventilator adjustments. Foreseeable adjustments include changes to FiO2, respiratory rate, and tidal volume. Once the desired PaO2 level is achieved ("time 0"), investigators will obtain an ABG q12 hours throughout the 48 hour interventional period. After maintaining the ventilator settings for 48 hours, ventilator management will revert to the clinical team. Blood and bronchoalveolar lavage (BAL) will be collected from the patient at time of enrollment.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Danger Associated Molecular Patterns (DAMP) Mediated Innate Immune Failure and Pneumonia After Trauma - the Harvard-Longwood (HALO) Campus Area Consortium
Actual Study Start Date : November 15, 2019
Estimated Primary Completion Date : November 1, 2022
Estimated Study Completion Date : November 1, 2024

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Normoxia with Normocarbia

Mechanical ventilation will be adjusted based on arterial blood gas results. Patient will remain on study settings for 48 hours from achieving target setting. Blood and BAL will be collected at the time of enrollment, at 24 hours, at 48 hours and at 72 hours.

PaO2 < 100 (FiO2 >= 21%) PaCO2 of 30-40

Other: Normoxia with Normocarbia
PaO2 < 100 (FiO2 >= 21%) PaCO2 of 30-40

Active Comparator: Normoxia with Hypercarbia

Mechanical ventilation will be adjusted based on arterial blood gas results. Patient will remain on study settings for 48 hours from achieving target setting. Blood and BAL will be collected at the time of enrollment, at 24 hours, at 48 hours and at 72 hours.

PaO2 < 100 (FiO2 >= 21%) PaCO2 of 50-60

Other: Normoxia with Hypercarbia
PaO2 < 100 (FiO2 >= 21%) PaCO2 of 50-60

Active Comparator: Hyperoxia with Normocarbia

Mechanical ventilation will be adjusted based on arterial blood gas results. Patient will remain on study settings for 48 hours from achieving target setting. Blood and BAL will be collected at the time of enrollment, at 24 hours, at 48 hours and at 72 hours.

PaO2 > 250 (FiO2 >= 70%) PaCO2 of 30-40

Other: Hyperoxia with Normocarbia
PaO2 > 250 (FiO2 >= 70%) PaCO2 of 30-40

Active Comparator: Hyperoxia with Hypercarbia

Mechanical ventilation will be adjusted based on arterial blood gas results. Patient will remain on study settings for 48 hours from achieving target setting. Blood and BAL will be collected at the time of enrollment, at 24 hours, at 48 hours and at 72 hours.

PaO2 > 250 (FiO2 >= 70%) PaCO2 of 50-60

Other: Hyperoxia with Hypercarbia
PaO2 > 250 (FiO2 >= 70%) PaCO2 of 50-60




Primary Outcome Measures :
  1. Inflammatory markers [ Time Frame: Change over hours 24, 48 and 72 ]
    ROS production (output is in relative light units per second (RLU/sec)) using luminol-dependent chemiluminescence, measured every 90 sec over the assay time-course of 60 min. Over thirty surface markers on neutrophil subpopulations, including CD10, CD11b, CD15, CD16, CD45, CD66b, CD45, CD274, CD279, and CD88, at various times after trauma will be analyzed using flow cytometry and CyTOF technology. Where indicated, activation of p38/MK2 intracellular signaling pathway will be analyzed by western blotting, and RNA expression profiles of individual cells will be attempted using single-cell RNA sequencing technologies.


Secondary Outcome Measures :
  1. Neutrophil activation [ Time Frame: Change over hours 24, 48 and 72 ]
    ROS production (output is in relative light units per second (RLU/sec)) using luminol-dependent chemiluminescence, measured every 90 sec over the assay time-course of 60 min. Over thirty surface markers on neutrophil subpopulations, including CD10, CD11b, CD15, CD16, CD45, CD66b, CD45, CD274, CD279, and CD88, at various times after trauma will be analyzed using flow cytometry and CyTOF technology. Where indicated, activation of p38/MK2 intracellular signaling pathway will be analyzed by western blotting, and RNA expression profiles of individual cells will be attempted using single-cell RNA sequencing technologies.

  2. Purine metabolism [ Time Frame: Change over hours 24, 48 and 72 ]
    Conversion of adenosine triphosphate (ATP) and adenosine diphosphate (ADP) into adenosine (ADO) in lymphomononuclear cells obtained from the peripheral blood and BAL of trauma patients and controls.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Expected to be on Control Mode Ventilation (CMV) for at least 48 hours from the time of screening

Exclusion Criteria:

  • Patients presenting with a primary acute neurological disorder
  • Patients who are post cardiac arrest
  • Known pregnancy
  • Concomitant enrollment in HALO as a case (trauma) patient
  • Not committed to full ventilator support
  • Treating physician refusal

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03993002


Locations
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United States, Massachusetts
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States, 02215
Sponsors and Collaborators
Beth Israel Deaconess Medical Center
United States Department of Defense
Investigators
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Principal Investigator: Daniel Talmor, MD MPH Beth Israel Deaconess Medical Center
Publications:
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Responsible Party: Beth Israel Deaconess Medical Center
ClinicalTrials.gov Identifier: NCT03993002    
Other Study ID Numbers: 2016P000144
PR151953 ( Other Grant/Funding Number: Department of Defense )
First Posted: June 20, 2019    Key Record Dates
Last Update Posted: April 28, 2020
Last Verified: April 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

The PI fully endorses the sharing of final research data to serve important scientific goals, to be done by publication, communications and online data "mixed mode" sets at the respective PI webpage. The PI will aim for the timely release and sharing of final research data from DoDsupported studies that will enable for use by other researchers.

The rights and privacy of individuals who participate in sponsored research must be protected at all times. Data intended for broader use should be free of identifiers that would permit linkages to individual research participants and variables that could lead to deductive disclosure of the identity of individual subjects. Should any intellectual property arise which requires a patent, the PI will ensure that the technology (materials and data) remains widely available to the research community in accordance with the NIH Principles and Guidelines documented in http://grants.nih.gov/grants/policy/data_sharing/data_sharing_brochure.pdf.

Time Frame: beginning 12 months after and ending 36 months after primary study publication.
Access Criteria: Proposals should be directed to dtalmor@bidmc.harvard.edu. To gain access, data requestors will need to sign a data access agreement and have any necessary ethics board approvals in place.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Beth Israel Deaconess Medical Center:
Mechanical Ventilation
Alevolar stretch
Hyperoxia
Normoxia
Hypercarbia
Normocarbia
Additional relevant MeSH terms:
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Pneumonia
Respiratory Insufficiency
Lung Diseases
Respiratory Tract Diseases
Respiratory Tract Infections
Respiration Disorders