Ventilator Monitoring in Early Exacerbation Detection

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. Identifier: NCT01644162
Recruitment Status : Completed
First Posted : July 18, 2012
Last Update Posted : October 17, 2014
Information provided by (Responsible Party):

Brief Summary:

The aim of this study is to determine whether respiratory disease exacerbations (a sudden worsening of symptoms) can be predicted by variables that are monitored by non-invasive ventilators (small machines that assist breathing) in patients requiring long term home ventilation.

The investigators hypothesise that acute exacerbations of patients with respiratory disease and ventilatory failure will be predicted by changes in the respiratory variables monitored and stored by ventilators during chronic home ventilator use.

Condition or disease Intervention/treatment Phase
Respiratory Failure Neuromuscular Disease Chest Wall Disorder Chronic Obstructive Pulmonary Disease Obesity Hypoventilation Syndrome Device: iVAPS ventilation Not Applicable

Detailed Description:

This pilot study is a proof of concept study investigating whether respiratory variables measured during chronic non-invasive ventilation (NIV) therapy may be used to predict a disease exacerbation.

Modern ventilators used in the home for chronic respiratory failure have the ability to monitor and store respiratory variables that may worsen during exacerbations, and may potentially detect exacerbations before symptoms become apparent. Normal pressure support ventilators monitor respiratory rate which might be expected to increase with worsening disease. In patients with obstructive airways disease an increase in expiratory time may potentially be observed with worsening airways obstruction. Adaptive servo ventilators, which modulate pressure support to maintain constant minute ventilation, may increase the amount of pressure support delivered if respiratory mechanics deteriorate as a result of an exacerbation.

Consenting experienced NIV users will be switched to an adaptive-servo ventilator with the capacity to monitor and store therapy data. The device being used is the Stellar 150 ventilator (Resmed, Ltd., Bella Vista, Australia) with hardware and software ability to measure variables such as respiratory rate, airflow, pressure support and leak.

Patients will use the ventilator for a total of 4 months during which they will complete daily symptom diaries, including medication use and peak flow measurements.

Changes in ventilator variables will be analysed and day to day variation identified. Changes will be compared with daily peak expiratory flow measures (an indication of how well the airways are functioning), patient symptoms, and healthcare utilization. Hospital admissions for exacerbations, GP consults, and healthcare team contacts will also be measured.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 30 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Use of Ventilator Monitoring for Early Detection of Exacerbations of Chronic Lung Disease
Study Start Date : July 2012
Actual Primary Completion Date : January 2014
Actual Study Completion Date : January 2014

Arm Intervention/treatment
iVAPS ventilation
3 months of ventilator use in iVAPS mode with data monitoring
Device: iVAPS ventilation
3 months of ventilation on iVAPS mode
Other Name: non-invasive ventilation

Primary Outcome Measures :
  1. Change in ventilator pressure support from baseline [ Time Frame: up to 3 months ]
    Pressure Support delivered by the adaptive-servo ventilator at Day 0 of exacerbation compared to the pressure support during baseline stable state.

Secondary Outcome Measures :
  1. Changes in ventilator-measured parameters from baseline [ Time Frame: Up to 3 months ]
    Changes in ventilator-measured parameters >15% from baseline [respiratory rate (RR), inspiratory time (Ti), pressure support (PS), Minute volume (MV), tidal volume (Vt), flow, leak, oxygen saturation (SaO2), pulse, I:E ratio, apnoea-hypopnea index (AHI), compliance]

  2. Exacerbation as determined by a change in patients subjective symptoms [ Time Frame: up to 3 months ]

    The presence of 2 or more subjective symptoms compared to baseline for 2 consecutive days;

    - breathlessness, increased sputum volume or sputum purulence, coryzal, wheeze or chest tightness, sore throat, cough, fever, sleep disruption, decreased physical activity

  3. Change in peak expiratory flow rate (PEFR)>15% from baseline [ Time Frame: Up to 3 months ]
    Change in peak expiratory flow rate (PEFR)>15% from baseline

  4. Exacerbation as defined by healthcare utilisation [ Time Frame: up to 3 months ]
    Exacerbation defined by the requirement of antibiotics +/- steroids, GP visit, accident and emergency visit, hospital admission

Information from the National Library of Medicine

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

Inclusion Criteria:

  • Patients with a diagnosis of obstructive (COPD, cystic fibrosis, bronchiectasis or chronic asthma) or restrictive (NMD, chest wall disorder) lung disease confirmed by a hospital consultant
  • aged > 18 years
  • established home ventilator user with ventilator prescribed for either chronic ventilatory failure or nocturnal hypoventilation
  • able to use bilevel positive pressure ventilation with Inspiratory positive airway pressure (IPAP) requirement <30cm H2O (Stellar ventilator - IPAP max 30)

Exclusion Criteria:

  • patients < 18 years
  • cognitive impairment sufficient to interfere with comprehension of the study or use of ventilator
  • poor adherence with non-invasive ventilation (<3hours/night for >10days/month)
  • Inspiratory positive airway pressure (IPAP) requirement >30cmH2O

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 identifier (NCT number): NCT01644162

United Kingdom
Royal Brompton Hospital
London, United Kingdom, SW3 6NP
Sponsors and Collaborators
Principal Investigator: Anita Simonds Royal Brompton & Harefield NHS Foundation Trust

Responsible Party: ResMed Identifier: NCT01644162     History of Changes
Other Study ID Numbers: 11/LO/1777
First Posted: July 18, 2012    Key Record Dates
Last Update Posted: October 17, 2014
Last Verified: March 2012

Keywords provided by ResMed:
Non-Invasive Positive-Pressure Ventilation
Disease Exacerbation
Respiratory Failure

Additional relevant MeSH terms:
Lung Diseases
Lung Diseases, Obstructive
Pulmonary Disease, Chronic Obstructive
Respiratory Insufficiency
Neuromuscular Diseases
Obesity Hypoventilation Syndrome
Respiratory Tract Diseases
Respiration Disorders
Nervous System Diseases
Signs and Symptoms, Respiratory
Signs and Symptoms
Sleep Apnea, Obstructive
Sleep Apnea Syndromes
Sleep Disorders, Intrinsic
Sleep Wake Disorders
Nutrition Disorders