Acute Lung Injury

Researchers are evaluating the use of early near apneic ventilation compared to usual ultra-protective lung ventilation in patients with severe acute respiratory distress syndrome ARDS who are supported by venovenous extracorporeal membrane oxygenation ECMO. The trial, named CALMDOWN, is a prospective, open-label, multicenter, randomized controlled study aiming to investigate whether early apneic ventilation can help reduce ventilator-induced lung injury, ECMO duration, and mortality by day 60 in this critically ill population. Participants are randomly assigned to one of two groups one group receives near apneic ventilation during the first 3 days of ECMO using BIPAPAPRV or pressure-controlled ventilation with specific settings to maintain airway pressure and minimize ventilation rate. Neuromuscular blockade and sedation may be used as needed. After 3 days, apneic ventilation may continue or switch to ultra-protective lung ventilation at the physicians discretion. The other group receives standard ultra-protective lung ventilation throughout ECMO support with defined ventilator settings. Prone positioning is allowed in both groups based on physician judgment. During the study, participants will be monitored closely for outcomes including mortality at day 60, need for lung transplantation, persistence of ECMO support, and days alive without ECMO from day 0 to day 60. Additional assessments cover mortality and other clinical outcomes up to day 90, duration of ventilation, ICU stay, hospital stay, and complications such as pneumonia, pneumothorax, and right ventricular function. The trial is sponsored by Assistance Publique - Hpitaux de Paris and runs until May 2030.

Researchers are studying lung mechanics during the early phase of mechanical ventilation in intensive care and during general anesthesia in surgical patients. The study aims to better understand lung compliance and transpulmonary driving pressures using a new, non-invasive PEEP-step method. This method could improve how ventilator settings are personalized to reduce lung injury and complications, addressing a gap in data collected during the critical first hours of ventilation. The study observes two groups ICU patients receiving ventilator treatment and patients undergoing general anesthesia for surgery. In both groups, a PEEP-step method involves adjusting positive end-expiratory pressure PEEP up and down in one or two steps while measuring changes in lung volume and pressures. This is done directly after intubation and repeated during ventilation or surgery when clinical events occur, using specialized software that analyzes data from standard ventilator monitoring equipment. Participants will be monitored continuously during ventilator treatment or surgery. Measurements include lung elastance and transpulmonary driving pressure, collected before, during, and after respiratory care. Clinical data such as blood gases and ventilator settings are recorded without any invasive procedures. The study assesses lung function changes over time, ventilator duration, and postoperative complications, aiming to enhance ventilator therapy and patient outcomes. Total participation time varies with clinical course.

Researchers are evaluating whether a structured training program for intensive care unit ICU staff can reduce health problems known as post-intensive care syndrome PICS in adults after they leave the hospital. PICS includes new or worsened physical, thinking, or emotional difficulties following serious illness, which can affect daily life, independence, memory, mood, and overall quality of life. This multicenter study compares patients treated before and after ICU staff training, focusing on whether the training reduces PICS three months after hospital discharge. The study also compares standard training on the ABCDEF care bundle with an expanded A-Z bundle that includes additional care elements like nutrition, sleep, infection prevention, safety, and psychological support. The study involves a cluster-randomized design where entire ICUs are assigned to receive training on either the standard ABCDEF bundle or the expanded A-Z bundle. The training program for ICU staff includes a month-long online course with educational materials, checklists, pocket guides, and visual reminders, plus face-to-face sessions to reinforce learning. After training, ICUs continue usual care while researchers track how often the trained care practices are followed during patients ICU stays, up to 21 days or until discharge or death. Follow-up visits for patients occur at 1, 3, 6, and 12 months after hospital discharge. Participants are adults who stay in the ICU for at least 48 hours and leave the hospital alive. They will undergo tests and questionnaires on physical health, memory, mood, and quality of life during follow-up visits. Data collection includes ICU care details and patient outcomes, monitored using electronic forms with quality checks. The main outcome measured is the number of participants who develop PICS three months after discharge. Secondary outcomes include adherence to care bundles, incidence of delirium, and quality of life assessments at various timepoints. The study runs until 2028 and maintains ethical and data protection standards throughout.

Researchers are studying patients with severe pneumonia admitted to the Respiratory Intensive Care Unit RICU to understand the epidemiology and clinical characteristics of pneumonia caused by various factors. This observational cohort study aims to gather detailed clinical data including morbidity, mortality, risk factors, symptoms, and radiographic changes to help improve clinical care for severe pneumonia patients. The study involves patients admitted to the RICU due to pneumonia from any cause. There are no specific treatments or interventions being tested, as this is an observational study collecting data during the patients stay. Researchers will observe respiratory support parameters, treatment options, and symptom developments during the initial days and weeks of hospitalization. Participants will be monitored for outcomes such as mortality and morbidity during their time in the RICU, with measurements taken over one year. Data on symptoms within the first 48 hours, respiratory support during the first 5 days, and treatments over 3 weeks will be collected. The study records clinical information to better understand pneumonia in this critical care setting, with participant involvement lasting as long as their hospital stay and follow-up for outcomes.

Researchers are conducting a clinical study to develop an artificial intelligence AI-based clustering model to personalize medicine for patients with acute respiratory failure who are admitted to the intensive care unit ICU. The study aims to confirm patient phenotypes and compare clinical characteristics and prognosis between patients requiring advanced oxygen support and a control group without acute respiratory failure. Participants are divided into two groups those with acute respiratory failure requiring treatment with high flow nasal cannula HFNC, non-invasive ventilation NIV, or mechanical ventilation MV, and a control group who do not need these treatments. Both groups are admitted to the internal medicine ICU at Samsung Seoul Hospital and undergo the same research procedures. During the study, participants clinical information is collected prospectively for analysis. Researchers will assess hospital mortality up to one year from admission, ICU mortality up to six months, and length of stay in both hospital and ICU. The study involves monitoring patients from admission until discharge or death, with follow-up periods varying up to one year. This observational study is sponsored by Samsung Medical Center.

Amyotrophic lateral sclerosis ALS is a progressive disease that weakens muscles and often leads to breathing problems, which is the leading cause of death in ALS. This research evaluates the timing and method of starting non-invasive ventilation NIV to assist breathing, as current guidelines vary and are not based on large studies. The study aims to explore early use of NIV in ALS patients before insurance criteria for coverage are met, using a new prediction tool to identify those at high risk of respiratory problems within six months. Participants will be randomly assigned to start early NIV or receive usual care, with the early NIV group receiving ventilation support earlier than current U.S. guidelines suggest. The study will collect data on feasibility, symptoms, carbon dioxide levels, and survival outcomes over about one year. The intervention involves using a ventilation device through a mask to help patients breathe and reduce carbon dioxide in the blood, potentially improving survival. Throughout the study, participants will undergo assessments including quality of life questionnaires, sleepiness scales, breathing function tests, and monitoring of NIV use and hospitalizations. The research team will measure the time to first NIV use, carbon dioxide levels, breathing symptoms, and survival without tracheostomy. Data collected will help plan a larger trial and understand which patients are likely to benefit from early NIV and use it consistently over time.

Researchers are studying the safety and tolerability of human umbilical cord mesenchymal stem cell injections for adults aged 18 to 80 with moderate to severe acute respiratory distress syndrome ARDS caused by infection. This Phase I-II open-label trial also explores the appropriate dosage, potential effects on the immune system, and how the treatment behaves in the body over time. Participants receive a single dose of stem cells delivered through a vein, with doses ranging from 5 x 107 to 2 x 108 cells. The study does not include a placebo group and focuses on dose escalation to assess safety. The trial is sponsored by Changchun Tuohua Pharmaceutical Co., Ltd. During the 28 days following treatment, participants will have their vital signs, lab tests, lung function, organ failure status, and oxygen levels monitored regularly. Researchers will track any side effects, mortality rates, and time spent without mechanical ventilation or intensive care. Long-term follow-up is also part of the study to further assess safety and effects.

This research aims to evaluate interventions to support family members who act as surrogate decision makers for critically ill patients in Intensive Care Units ICUs. These surrogates often face intense grief and stress that can affect their mental health and the quality of decisions made for their loved ones near end-of-life. The study focuses on reducing symptoms of prolonged grief disorder PGD, post-traumatic stress disorder PTSD, and related emotional challenges through a psychological intervention called EMPOWER. The study compares two approaches the EMPOWER intervention, which is a brief, cognitive-behavioral and acceptance-based treatment delivered by trained mental health professionals, and a Supportive Conversation SC that provides empathetic support without specific skill-building. EMPOWER includes six 15-minute modules and two booster phone sessions, totaling about 90 minutes plus follow-ups, while the Supportive Conversation matches this time with supportive interaction and follow-up calls. Participants are assessed up to four times before and after the intervention within three months. Participants, who are surrogate decision makers of ICU patients near end-of-life, will complete assessments on grief, PTSD, depression, regret, anxiety, and distress before the intervention, immediately after, and at 3 and 12 months follow-up. The study also includes interviews with some participants to better understand the interventions effects and contextual factors during the COVID-19 pandemic. The primary outcomes focus on changes in grief and PTSD symptoms over twelve months, with safety and mental health monitored throughout the study period.

Researchers are evaluating the efficacy and safety of a single intravenous dose of agenT-797 combined with standard of care SOC compared to placebo plus SOC in adults with severe pneumonia and moderate to severe acute hypoxemic respiratory failure AHRF. This trial includes a run-in phase and a double-blinded phase 2, designed to reduce short-term mortality and improve clinical outcomes in this serious condition. The trial consists of two parts an initial open-label Run-in Phase where participants receive agenT-797 plus SOC to characterize the baseline population, followed by a randomized, double-blinded Phase 2 where participants receive either agenT-797 plus SOC or placebo plus SOC. SOC includes antimicrobial therapy and corticosteroids based on applicable guidelines. Treatments are given as intravenous infusions. Participants will be monitored from Day 1 through Day 28 for outcomes such as mortality, oxygenation support-free days, ventilator-free days, ICU-free days, new infections, antibiotic-free days, and time to hospital discharge. Additional assessments include cytokine profile changes at baseline, Day 3, Day 7, and Day 14. The study continues monitoring mortality up to Day 90. Overall, participants undergo intensive evaluations, including safety and efficacy assessments, during the study period lasting until 2027.

Researchers are evaluating the effectiveness of three glucocorticoid drugsmethylprednisolone, dexamethasone, and hydrocortisonein patients with acute respiratory distress syndrome ARDS. ARDS is a serious condition caused by severe inflammation in the lungs, often following pneumonia or sepsis, leading to breathing difficulties. The study aims to compare these drugs at equivalent doses to understand their impact on inflammation and lung function in ARDS patients. The study involves three groups of 100 patients each, receiving either methylprednisolone at 1 mgkgday, dexamethasone at 13 mgday, or hydrocortisone at 350 mgday. These drugs are given during the early phase of ARDS, when inflammation is most active. The study is randomized and does not use masking. Participants receive treatment and are monitored closely during a 28-day period. Participants will be assessed for outcomes such as 28-day mortality, need for invasive mechanical ventilation, number of ventilator-free days, length of ICU stay, hospitalization duration, and occurrence of serious side effects like infections and high blood sugar. The study includes chest imaging and oxygen level monitoring to confirm ARDS diagnosis and track progress. The total participation period for each patient is 28 days from enrollment.