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NCT04347941: APPROVE-CARE

Awake Prone Positioning to Reduce Invasive VEntilation in COVID-19 Induced Acute Respiratory failurE

Terminated NA Results posted Last updated 2 December 2021
What this trial tests

NA trial testing Prone Positioning in ARDS, Human in 24 participants. Terminated before completion.

Timeline
11 July 2020
Primary endpoint
26 January 2021
26 January 2021

Quick facts

Lead sponsorUniversity College Hospital Galway
PhaseNA
StatusTerminated
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingdouble
Primary purposetreatment
Enrollment24
Start date11 July 2020
Primary completion26 January 2021
Estimated completion26 January 2021
Sites1 location across Ireland

Drugs / interventions tested

Conditions studied

Sponsor

University College Hospital Galway

Who can join

18 and older, any sex, with ARDS, Human or Mechanical Ventilation Complication. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

The Effect of Prone Positioning on Requirement for Invasive Mechanical Ventilation or Death in Patients With COVID 19 Induced Respiratory Failure. Primary · Up to 28 days post randomisation

A measure of effect of awake prone positioning in patients with confirmed or suspected COVID-19 acute hypoxemic respiratory failure undergoing supplemental oxygen via high flow nasal cannular oxygen on reducing requirement for invasive mechanical ventilation or death. Outcome measure is calculated as a count of the number of patients who went onto require invasive mechanical ventilation or died up to 28 days post randomization.

GroupValue95% CI
Prone Positioning0
Standard Care2
Length of Time Tolerating Prone Positioning Secondary · Daily during intervention up to 14 days post randomisation

description of duration of prone positioning in hours per day from day 0 to day 14 in trial

GroupValue95% CI
Prone Positioning3.3± 2.7
Standard Care1.0± 2.5
PaO2/FiO2 Ratio Measured Before Prone Positioning Secondary · Immediately before intervention

Measure of change in oxygenation before intervention in the patients assigned to awake prone positioning

GroupValue95% CI
Prone Positioning144± 52
Standard of Care114± 40
PaO2/FiO2 Ratio After 1 Hours of Prone Positioning Secondary · During intervention

Measure of change in oxygenation following patients being placed in the prone position for 1 hour

GroupValue95% CI
Prone Positioning33± 32
SpO2/FiO2 Ratio Measured Before Prone Positioning Secondary · Immediately before intervention

Measure of oxygenation using pulse oximetry before intervention where ABG not available

GroupValue95% CI
Prone Positioning193± 45
Standard of Care178± 52
SpO2/FiO2 Ratio After 1 Hour in Prone Positioning Secondary · During Intervention

Measure of oxygenation 1 hour after intervention where ABG not available

GroupValue95% CI
Prone Positioning247± 53
Number Requiring Increase in Ventilatory Assistance Secondary · Up to 28 days post randomisation

Number of patients in each group requiring an increase in the respiratory support from baseline high flow nasal cannula oxygen post randomization up to 28 days later, defined as need for continuous positive airway pressure (CPAP), bilevel positive airway pressure (biPAP)

GroupValue95% CI
Prone Positioning4
Standard Care4
Use of Awake Prone Positioning as a Rescue Intervention in Control Patients Secondary · Up to 28 days post randomisation

Number of patients who underwent rescue awake prone positioning in control patients by physicians in response to hypoxia

GroupValue95% CI
Standard Care0

Sponsor's own description

Prone positioning (PP) is an effective first-line intervention to treat moderate-severe acute respiratory distress syndrome (ARDS) patients receiving invasive mechanical ventilation, as it improves gas exchanges and lowers mortality.The use of PP in awake self-ventilating patients with (e.g. COVID-19 induced) ARDS could improve gas exchange and reduce the need for invasive mechanical ventilation, but has not been studied outside of case series.The investigators will conduct a randomized controlled study of patients with COVID-19 induced respiratory failure to determine if prone positioning reduces the need for mechanical ventilation compared to standard management.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted?
    Fan E, Beitler JR, Brochard L, Calfee CS, et al · · 2020 · cited 342× · PMID 32645311 · DOI 10.1016/s2213-2600(20)30304-0
  2. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial.
    Ehrmann S, Li J, Ibarra-Estrada M, Perez Y, et al · · 2021 · cited 271× · PMID 34425070 · DOI 10.1016/s2213-2600(21)00356-8
  3. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.
    Nasa P, Azoulay E, Khanna AK, Jain R, et al · · 2021 · cited 126× · PMID 33726819 · DOI 10.1186/s13054-021-03491-y
  4. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study.
    Ferrando C, Mellado-Artigas R, Gea A, Arruti E, et al · · 2020 · cited 115× · PMID 33023669 · DOI 10.1186/s13054-020-03314-6
  5. Awake prone positioning for hypoxaemic respiratory failure: past, COVID-19 and perspectives.
    Touchon F, Trigui Y, Prud'homme E, Lefebvre L, et al · · 2021 · cited 40× · PMID 33952601 · DOI 10.1183/16000617.0022-2021
  6. Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review.
    Weatherald J, Solverson K, Zuege DJ, Loroff N, et al · · 2021 · cited 37× · PMID 33096347 · DOI 10.1016/j.jcrc.2020.08.018
  7. Prone position in COVID 19-associated acute respiratory failure.
    Kharat A, Simon M, Guérin C. · · 2022 · cited 24× · PMID 34750322 · DOI 10.1097/mcc.0000000000000900
  8. COVID-19 Critical Illness: A Data-Driven Review.
    Ginestra JC, Mitchell OJL, Anesi GL, Christie JD. · · 2022 · cited 24× · PMID 34520220 · DOI 10.1146/annurev-med-042420-110629

Verify or expand the search:

Other trials of Prone Positioning

Trials testing the same drug.

Other recruiting trials for ARDS, Human

Currently open trials in the same condition.

Other University College Hospital Galway trials

Trials by the same sponsor.

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Data sources for this page

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Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing