Bubble Continuous Positive Airway Pressure for Children With Severe Pneumonia in Mali, Africa
Primary Purpose
Pneumonia
Status
Terminated
Phase
Not Applicable
Locations
Mali
Study Type
Interventional
Intervention
Bubble CPAP
Standard Therapy
Sponsored by
About this trial
This is an interventional treatment trial for Pneumonia
Eligibility Criteria
Inclusion criteria:
Cases must meet the all following inclusion criteria for eligibility to be placed on bCPAP
- Hospitalization
- Age 12 months up to 5 years
Fast breathing defined as: (Using a timing device to count rate for one full minute)
- ≥ 40 breath/min in a child aged 12-23 months
- ≥ 30 breaths/min in a child aged 2-5 years
- Any of the following respiratory signs: wheezing, nasal flaring, chest indrawing, cyanosis, grunting, head nodding, stridor and/or oxygen saturation <90%.
- Informed written consent obtained Or
- Age 12 months up to 5 years
- Weight up to 20Kg
With cough AND/OR any sign of difficult breathing Plus ONE general danger sign as follow:
- Not able to drink
- Persistent vomiting
- Convulsions
- Lethargy or unconscious
- Stridor in a calm child or
- Severe malnutrition
- Informed written consent obtained
Patients with the following conditions who meet eligible criteria can benefit from bCPAP:
- Bronchiolitis
- Respiratory viral infection
- Lung collapse / atelectasis
- Asthma exacerbation
- Patients with congenital heart disease with heart failure
- Malaria
- Severe Anemia
- Sepsis
- Meningitis
- Any patient with increased respiratory effort who meet the eligible criteria
We will include patients with progression to severe pneumonia during the hospitalization and those ones with chronic diseases too.
Definitions:
- Head nodding: a movement of the head synchronous with inspiration indicating severe respiratory distress
- Chest indrawing: lower chest wall goes in when the child breathes in
- Lethargy: is defined as "an infant who does not wake up on stimulation or, on waking, subsequently moves only on stimulation or does not move at all"
- Not able to drink: refers to "difficulty feeding or not feeding well (in an infant who was previously feeding well)"
- Convulsions: During the enrollment process, the danger sign for 'convulsions' will be collected by asking about the number and duration of seizures.
- Severe malnutrition Severe acute malnutrition is defined as per WHO as the presence of edema of both feet or severe wasting (weight-for-height/length <-3SD) or mid upper arm circumference < 115 mm [19]
- Progression to case definition during hospitalization: Cases that progress to severe pneumonia or meet the inclusion criteria previously mentioned during hospitalization but do not meet the definition during the time of admission because the disease is in the early stages of illness will be included.
- Chronic disease: Children with chronic lung or respiratory disease may be admitted to the study. We will not exclude patients from the study on the basis of a long history of symptoms.
Exclusion criteria:
Cases that meet any of the following exclusion criteria will be ineligible to enroll:
- Skin breakdown around the nose and mouth
- Facial trauma
- Persistent episodes of vomiting: more than 3 episodes in 1 hour.
Sites / Locations
- Center for Vaccine Development - Mali
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Other
Arm Label
Bubble CPAP
Standard Therapy
Arm Description
Outcomes
Primary Outcome Measures
Treatment failure rate
We define treatment failure as the occurrence of any two or more of the following clinical criteria 2 hour after initiation of an intervention:
Severe hypoxemia (Saturation of oxygen SpO2 <85%) after being on one of the study groups treatments for 2 hours
Increased in respiratory rate by any amount or if respiratory rate remains unchanged after initiation of treatment as follow:
≥ 40 breath/min in a child aged 12-23 months
≥ 30 breaths/min in a child aged 2-5 years
Signs of persistent severe respiratory distress defined as head nodding, severe chest indrawing, stridor, apnea, nasal flaring and or grunting.
Dies while in the hospital.
Secondary Outcome Measures
Mortality rate
The difference in mortality between the standard therapy group vs bCPAP group at the time of discharge.
Full Information
NCT ID
NCT03944551
First Posted
April 22, 2019
Last Updated
June 4, 2020
Sponsor
University of Maryland, Baltimore
Collaborators
Center for Vaccine Development - Mali
1. Study Identification
Unique Protocol Identification Number
NCT03944551
Brief Title
Bubble Continuous Positive Airway Pressure for Children With Severe Pneumonia in Mali, Africa
Official Title
Use of Bubble Continuous Positive Airway Pressure (bCPAP) With High Flow Settings in Treatment of Respiratory Distress Secondary to Signs of Severe Pneumonia in Pediatric Patients in Mali
Study Type
Interventional
2. Study Status
Record Verification Date
June 2020
Overall Recruitment Status
Terminated
Why Stopped
Participant mortality rates were higher than expected.
Study Start Date
September 26, 2019 (Actual)
Primary Completion Date
September 30, 2019 (Actual)
Study Completion Date
September 30, 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Maryland, Baltimore
Collaborators
Center for Vaccine Development - Mali
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
This study is being conducted in Mali, Africa.
Pneumonia is a respiratory infection of the lungs caused by bacteria or virus. Some children can develop signs of severe pneumonia and as a result, have difficulty breathing and low levels of oxygen in the blood. In some cases this can progress to death. Patients with signs of severe pneumonia require admission to the hospital for treatment and the treatment includes delivery of oxygen. Currently, in the hospital, oxygen is available for delivery by nasal cannula to children. In this case, oxygen is given through a small plastic tube which delivers oxygen through the nose. However, the amount of oxygen that can be given is limited because of the size of the tube and the amount of oxygen that can go through. However, a new device known as the bubble CPAP machine delivers oxygen through the nose in a way that helps the airways to stay open. This is known to provide better support to children less than 1 year of age who have difficulty breathing with signs of severe pneumonia. The purpose of this study is to evaluate the effectiveness of bubble CPAP in Children up to 5 years of age with with signs of severe pneumonia.
Detailed Description
This study includes two cohorts. One cohort will participate in an interventional clinical trial and the other cohort will participate in an observational study.
Interventional Cohort:
The first cohort will include 600 children with signs of severe pneumonia, 1 year up to 5 years of age. Signs of severe pneumonia include fast breathing, difficulty breathing and who are very sick (not able to drink, vomiting, having seizures, are very sleepy or with severe malnutrition). Two out of every three children will receive oxygen with the bubble CPAP and one out of every three children will receive treatment with oxygen with regular nasal cannula. The treatment assignment will be determined randomly. We will follow up participants during their entire hospitalization. During this time we will collect information on the child's illness, test results and treatment.
Observational Cohort:
The second cohort will include 450 children with signs of severe pneumonia, under 1 year of age. In Mali, bubble CPAP is currently given as standard of care (when possible) for children with signs of severe pneumonia, under 1 year of age; therefore, children in this cohort will already be receiving bubble CPAP as standard of care prior to enrollment. The only research activities will be to follow the children during their hospitalization and collect information about their clinical condition, test results, treatment and the amount of oxygen required during the hospital admission.
The remainder of the information in this ClinicalTrials.gov registration will refer only to the Intervention Cohort.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pneumonia
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
This is an unblinded, age-stratified, randomized trial with a 2:1 allocation ratio.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
13 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Bubble CPAP
Arm Type
Experimental
Arm Title
Standard Therapy
Arm Type
Other
Intervention Type
Device
Intervention Name(s)
Bubble CPAP
Intervention Description
Those assigned to the bCPAP group will receive a Total flow oxygen at a rate of 2 liters per kilogram to a maximum of 10 liters per minute using the appropriate nasal prongs for the age and size of the patient. The positive end-expiratory pressure (PEEP) provide by bCPAP will start at 8cm HO2. The FIO2 will be adjusted to obtain a saturation of oxygen of 90% or greater.
Intervention Type
Other
Intervention Name(s)
Standard Therapy
Intervention Description
For patients in the standard therapy group, oxygen will be delivery by nasal cannula at a flow rate of 4 Liters per minute. If a patient in the standard group after 1 hour of treatment still has a SpO2 < 90% or meeting criteria of treatment failure the patient will be move from the standard therapy group to the bCPAP group.
Primary Outcome Measure Information:
Title
Treatment failure rate
Description
We define treatment failure as the occurrence of any two or more of the following clinical criteria 2 hour after initiation of an intervention:
Severe hypoxemia (Saturation of oxygen SpO2 <85%) after being on one of the study groups treatments for 2 hours
Increased in respiratory rate by any amount or if respiratory rate remains unchanged after initiation of treatment as follow:
≥ 40 breath/min in a child aged 12-23 months
≥ 30 breaths/min in a child aged 2-5 years
Signs of persistent severe respiratory distress defined as head nodding, severe chest indrawing, stridor, apnea, nasal flaring and or grunting.
Dies while in the hospital.
Time Frame
2 hours
Secondary Outcome Measure Information:
Title
Mortality rate
Description
The difference in mortality between the standard therapy group vs bCPAP group at the time of discharge.
Time Frame
Through hospital discharge, an average of 1 week
10. Eligibility
Sex
All
Minimum Age & Unit of Time
12 Months
Maximum Age & Unit of Time
5 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria:
Cases must meet the all following inclusion criteria for eligibility to be placed on bCPAP
Hospitalization
Age 12 months up to 5 years
Fast breathing defined as: (Using a timing device to count rate for one full minute)
≥ 40 breath/min in a child aged 12-23 months
≥ 30 breaths/min in a child aged 2-5 years
Any of the following respiratory signs: wheezing, nasal flaring, chest indrawing, cyanosis, grunting, head nodding, stridor and/or oxygen saturation <90%.
Informed written consent obtained Or
Age 12 months up to 5 years
Weight up to 20Kg
With cough AND/OR any sign of difficult breathing Plus ONE general danger sign as follow:
Not able to drink
Persistent vomiting
Convulsions
Lethargy or unconscious
Stridor in a calm child or
Severe malnutrition
Informed written consent obtained
Patients with the following conditions who meet eligible criteria can benefit from bCPAP:
Bronchiolitis
Respiratory viral infection
Lung collapse / atelectasis
Asthma exacerbation
Patients with congenital heart disease with heart failure
Malaria
Severe Anemia
Sepsis
Meningitis
Any patient with increased respiratory effort who meet the eligible criteria
We will include patients with progression to severe pneumonia during the hospitalization and those ones with chronic diseases too.
Definitions:
Head nodding: a movement of the head synchronous with inspiration indicating severe respiratory distress
Chest indrawing: lower chest wall goes in when the child breathes in
Lethargy: is defined as "an infant who does not wake up on stimulation or, on waking, subsequently moves only on stimulation or does not move at all"
Not able to drink: refers to "difficulty feeding or not feeding well (in an infant who was previously feeding well)"
Convulsions: During the enrollment process, the danger sign for 'convulsions' will be collected by asking about the number and duration of seizures.
Severe malnutrition Severe acute malnutrition is defined as per WHO as the presence of edema of both feet or severe wasting (weight-for-height/length <-3SD) or mid upper arm circumference < 115 mm [19]
Progression to case definition during hospitalization: Cases that progress to severe pneumonia or meet the inclusion criteria previously mentioned during hospitalization but do not meet the definition during the time of admission because the disease is in the early stages of illness will be included.
Chronic disease: Children with chronic lung or respiratory disease may be admitted to the study. We will not exclude patients from the study on the basis of a long history of symptoms.
Exclusion criteria:
Cases that meet any of the following exclusion criteria will be ineligible to enroll:
Skin breakdown around the nose and mouth
Facial trauma
Persistent episodes of vomiting: more than 3 episodes in 1 hour.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Adnan T Bhutta, MBBS
Organizational Affiliation
University of Maryland, Baltimore
Official's Role
Principal Investigator
Facility Information:
Facility Name
Center for Vaccine Development - Mali
City
Bamako
Country
Mali
12. IPD Sharing Statement
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Bubble Continuous Positive Airway Pressure for Children With Severe Pneumonia in Mali, Africa
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