St Albert

This trial evaluates the effects of different dose-intensities of continuous renal replacement therapy CRRT in critically ill patients with acute kidney injury AKI in the intensive care unit. The main goal is to compare the current standard CRRT dose-intensity with a lower dose to see if the lower dose is not worse and might improve kidney recovery and shorten the duration of CRRT. The study addresses the lack of clear evidence on the minimum effective CRRT dose and aims to generate high-quality data that could influence clinical guidelines and practice. Participants will be randomly assigned to receive either a low dose-intensity CRRT of 10-15 mLkghour or the standard dose-intensity of 25-30 mLkghour while on CRRT. The lower dose is based on observational data suggesting it may be safe and well tolerated. The trial is a pilot feasibility study designed to inform a larger randomized controlled trial. Treatments will be delivered continuously while patients are in the ICU needing CRRT. During the study, participants will be monitored for the delivered CRRT dose-intensity over about one month. Researchers will assess feasibility factors such as consent rate, adherence to dose, recruitment rate, and outcome ascertainment up to 90 days. The primary outcome focuses on the difference in CRRT dose delivered. Participants will receive regular evaluations to track kidney recovery, time on CRRT, and overall treatment effects. The trial runs from November 2024 to June 2027.

Researchers are evaluating different partial wrist fusion techniques for adults with post-traumatic wrist arthritis, specifically those with stage II or III scapholunate advanced collapse SLAC or scaphoid nonunion advanced collapse SNAC. This randomized clinical trial compares two surgical methods to determine which provides better clinical and radiographic outcomes. The study is designed as a multi-center, double-blind, prospective trial to guide surgical decisions for patients needing wrist fusion surgery. Participants will be randomly assigned to one of two groups Group A will undergo four-corner arthrodesis, where the scaphoid is removed and the lunate, capitate, triquetrum, and hamate bones are fused. Group B will have partial wrist arthrodesis with triquetral excision, where both the scaphoid and triquetrum are removed and either three-corner or capitolunate fusion is performed. The study includes pre-operative assessment and follow-ups at 6 weeks, 3, 6, and 12 months post-surgery. During the study, participants will complete grip strength tests, wrist range of motion measurements, and various questionnaires assessing pain and wrist function at multiple points. Radiographs and complication tracking will also be done at each visit. The primary outcome is grip strength compared between groups over 12 months. Analysis will consider age and sex, using statistical modeling to compare results, aiming to inform which surgical technique best preserves wrist function and patient-reported outcomes.

Researchers are studying adults and children who have survived COVID-19 or acute respiratory infections and were critically ill in intensive care units ICUs. This study aims to understand how frailty, a condition of reduced health and function, affects survival and health outcomes after critical illness. It also examines the types of rehabilitation patients receive and the impact on their quality of life. The study includes both adults and pediatric patients admitted to participating ICUs and pediatric ICUs PICUs. Participants include adults aged 18 and older and children under 18 who were diagnosed with COVID-19, multi-system inflammatory syndrome in children MIS-C, or other acute respiratory infections. Eligible patients required advanced respiratory support such as invasive or non-invasive ventilation or high-flow oxygen within 14 days of ICU admission. The study observes patients without altering their care, gathering data about their frailty level, function, therapies, and rehabilitation received during and after ICU stay. During the study, researchers will collect information on frailty using the Clinical Frailty Score for adults and the Functional Status Score for children at hospital discharge and six months after ICU admission. They will also assess adults daily living activities and quality of life and childrens fatigue and well-being through specific questionnaires. The study will track post-hospital discharge locations and health outcomes to better understand rehabilitation needs and improve future treatments. Participation lasts through hospital discharge and up to six months post-ICU admission.

This trial evaluates Tezepelumab, a newly approved medication for adults with severe asthma who experience sudden worsening symptoms that require emergency care. The study aims to determine if starting Tezepelumab in the Emergency Department can help control asthma symptoms and reduce repeated visits or the need for steroid treatments. Adults with a history of asthma and recent exacerbations are the focus, and the trial compares Tezepelumab to a placebo in a phase 4 randomized, double-blinded study. Participants are randomized to receive either Tezepelumab 210 mg or a matching placebo through subcutaneous injections every four weeks for 90 days. After this period, all participants enter an open-label extension where they receive Tezepelumab for an additional 90 days. The study tracks the proportion of patients returning to the Emergency Department for asthma exacerbations during the first 90 days and again by day 180, while also monitoring other asthma control measures and drug safety. During the study, participants undergo regular assessments including asthma control questionnaires, lung function tests, and blood tests to measure inflammatory markers. The primary outcome is the rate of moderate and severe asthma exacerbations by day 90. Safety and tolerability of the medication are monitored throughout, and participants are followed for a total of 180 days. This research is sponsored by the University of Alberta and aims to provide important data on managing severe asthma in emergency settings.

Researchers are evaluating the use of esophageal pressure-guided positive end-expiratory pressure PEEP titration in patients with respiratory failure who have a body mass index BMI of 30 kgm2 or higher and require mechanical ventilation. This randomized controlled feasibility study aims to determine if a larger definitive trial is practical and to compare the effects of this specialized PEEP titration method against standard care on respiratory mechanics and clinical outcomes. The trial is conducted in a hospital setting and focuses on patients with obesity undergoing invasive ventilation. Participants will be randomly assigned to one of two groups one receiving esophageal pressure-guided PEEP titration, where an esophageal balloon catheter is placed within 4 hours after randomization to guide PEEP adjustments targeting an end-expiratory transpulmonary pressure of 0-2 cmH2O with higher targets allowed for severe hypoxemia, and the other receiving standard care PEEP management without esophageal monitoring. The esophageal catheter is repositioned and PEEP reassessed twice daily and removed before extubation or after 28 days. Standard care follows institutional guidelines, including ARDSNet tables for ARDS patients. During the study, participants will have continuous monitoring of respiratory parameters, including PEEP levels, driving pressures, oxygenation ratios, days free of mechanical ventilation, ICU-free days, and mortality up to hospital discharge or 30 days. The primary outcome is the feasibility of conducting a larger trial over 14 months. Safety limits on pressures and hemodynamic stability will be monitored. The total study duration includes assessments in the first 7 days and follow-up until hospital discharge or 30 days after enrollment.