Mechanical Insufflation-Exsufflation (Cough Assist) in Critically Ill Adults

Last updated: December 5, 2024
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Overall Status: Terminated

Phase

N/A

Condition

N/A

Treatment

Mechanical Insufflation-Exsufflation

Clinical Study ID

NCT06027008
ACACIA
  • Ages > 18
  • All Genders

Study Summary

The goal of this randomized feasibility trial is to evaluate the feasibility of Mechanical Insufflation-Exsufflation (MI-E) in invasively ventilated critically ill patients.

The main question[s] it aims to answer are:

  • Is MI-E feasible?

  • Is MI-E safe?

Participants in the intervention group will receive:

  • MI-E

  • Airway secretions will be removed by endotracheal suctioning, as part of routine airway care.

  • Manual hyperinflation will only be used when necessary in an emergency situation. Patients in the control group will receive endotracheal suctioning and manual hyperinflation when clinically indicated.

The primary outcome is the proportion of delivered MI-E sessions (2 times per calendar day a MI-E session of 3 x 3 cycles of an in- and exsufflation) per patient according to study protocol (feasibility). Secondary outcomes are the total number of serious adverse events in relation to MI-E (safety) and preliminary exploratory data on the need for airway care interventions and clinical outcomes including duration of invasive ventilation, length of stay in ICU and mortality (efficacy).

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • admission to one of the participating ICUs;

  • receiving invasive mechanical ventilation via an endotracheal tube; and

  • expected to need invasive ventilation for more than 48 hours from consideration forinclusion.

Exclusion

Exclusion Criteria:

  • use of MI-E before hospital admission, i.e., at home;

  • known presence of bullous emphysema;

  • known bronchopleural fistula;

  • known pneumothorax or pneumomediastinum;

  • known rib fractures;

  • known barotrauma;

  • known unstable spinal fractures;

  • unsecured subarachnoidal haemorrhage;

  • uncontrollable intracranial pressures; and

  • any infection, or colonization with pathogens that requires strict aerogenicisolation. With an exception for patients in cohort isolation due to COVID-19.

Study Design

Total Participants: 7
Treatment Group(s): 1
Primary Treatment: Mechanical Insufflation-Exsufflation
Phase:
Study Start date:
October 30, 2023
Estimated Completion Date:
October 01, 2024

Study Description

Bedside nurses, trained in using the MI-E device, will apply MI-E sessions at two moments per calendar day (morning and afternoon) for a maximum of 7 days while a patient is invasively ventilated.

MI-E settings are a 2-second insufflation and an immediate 2-second exsufflation. The cycles of the MI-E session will be performed with a positive and negative pressure of 40 cmH2O. The program is set up with the possibility of auto-triggering by the patient.

Connect with a study center

  • Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

    Amsterdam,
    Netherlands

    Site Not Available

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