REDOX-AHF: Oxygen Targets in Acute Heart Failure With Pulmonary Congestion
Study Details
Study Description
Brief Summary
This investigator-initiated, prospective, randomized, blinded, multi-center, controlled trial will investigate the effect of a restrictive vs. liberal oxygenation-strategy in patients hospitalized with acute heart failure with pulmonary congestion.
Patients will be randomized 1:1 in the emergency department to either liberal or restrictive oxygenation after providing informed written consent.
-
Liberal oxygenation group = SpO2 target of 96%.
-
Restrictive oxygenation group = SpO2 target of 90%.
The allocation will be concealed through the use of an oxygen-delivery robot, termed O2MATIC. The study will include 122 patients.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
Phase 2/Phase 3 |
Detailed Description
Background:
One million hospitalizations occur each year with a primary diagnosis of acute heart failure in the USA, with comparable numbers in Europe. Most patients with acute heart failure are treated with supplemental oxygen during hospitalization and guidelines recommend initiation of oxygen therapy if SpO2 <90% (class I, level C). However, no clinical trials of oxygen targets in humans with acute heart failure investigating clinically relevant endpoints have been performed.
Primary objective:
To investigate the effect of a restrictive vs. liberal oxygenation-strategy in patients hospitalized with acute heart failure.
Hypothesis:
Restrictive oxygenation is associated with improved clinical outcome compared to liberal oxygenation.
Design: Investigator-initiated, prospective, randomized, blinded, multi-center, controlled trial.
Intervention:
Patients will be randomized 1:1 in the emergency department to either liberal or restrictive oxygenation after providing informed written consent.
-
Liberal oxygenation group = SpO2 target of 96%.
-
Restrictive oxygenation group = SpO2 target of 90%.
Patients will have nasal cannula or oxygen mask placed as the usual care, and oxygen is titrated to the prespecified target range.
Consented patients will be randomly allocated to study groups via the automated web-based system within REDCap. The allocation will be concealed. Time at randomization will be considered as study time zero (T0). All patients will receive usual standard of care except for their oxygen-administration.
The intervention-phase will be 24 h, and hereafter oxygen therapy will be at the discretion of the treating physician.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: Liberal oxygenation group SpO2 target of 96% |
Drug: Oxygen
Patients will have nasal cannula or oxygen mask placed as the usual standard of care.
Patients will be screened and randomized in the emergency department to either liberal or restrictive oxygenation after providing informed written consent and oxygen is titrated to the prespecified target range using an automated feedback device (O2MATIC). Consented patients will be randomly allocated to study groups via the web-based system within REDCap. The allocation will be concealed. Time at randomization will be considered as study time zero (T0). All patients will receive usual standard of care except for their O2 management. The intervention will last for 24 h. After 24 h, patients will be switched over to usual care for oxygen therapy. If the treating physician thinks, that the patient need another oxygenation target and it is thought to be harmful to continue with the allocated target, the intervention-phase can be stopped prematurely.
|
Active Comparator: Restrictive oxygenation group SpO2 target of 90%. |
Drug: Oxygen
Patients will have nasal cannula or oxygen mask placed as the usual standard of care.
Patients will be screened and randomized in the emergency department to either liberal or restrictive oxygenation after providing informed written consent and oxygen is titrated to the prespecified target range using an automated feedback device (O2MATIC). Consented patients will be randomly allocated to study groups via the web-based system within REDCap. The allocation will be concealed. Time at randomization will be considered as study time zero (T0). All patients will receive usual standard of care except for their O2 management. The intervention will last for 24 h. After 24 h, patients will be switched over to usual care for oxygen therapy. If the treating physician thinks, that the patient need another oxygenation target and it is thought to be harmful to continue with the allocated target, the intervention-phase can be stopped prematurely.
|
Outcome Measures
Primary Outcome Measures
- Pulmonary parenchymal fluid content after 24 hours [24 hours]
Pulmonary parenchymal fluid content after 24 hours preceded by 10 minutes without oxygen-supplementation assessed noninvasively by the remote dielectric sensing (ReDS) device (Sensible Medical, Netanya, Israel)
Secondary Outcome Measures
- All-cause mortality [30 days]
Death from all causes
- Days alive out-of-hospital [30 days]
- Time to freedom from oxygen-supplementation [48 hours]
- 4) Change from baseline in log-transformed biomarkers N-Terminal Pro-Brain Natriuretic Peptide to 24 hours from admission. [24 hours]
- 5) Arterial blood gas concentration after 24 hours preceded by 10 minutes without oxygen-supplementation. [24 hours]
- Tricuspid annular plane systolic excursion [24 hours]
- Global longitudinal strain of the right ventricle [24 hours]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Age ≥ 18 years
-
Acute (within minutes to days) onset or worsening of subjective dyspnea
-
Oxygen saturation <92% (on arterial blood gas) or need of oxygen
-
At least one of the following clinical or radiological signs of congestion:
-
Pulmonary rales 2. Chest X-ray or CT with pulmonary congestion 3. Lung ultrasound with multiple B-lines
Exclusion Criteria:
-
More than 4 hours from hospital admission to randomization
-
Suspected infection or sepsis
-
Known severe pulmonary disease
-
Systolic blood pressure <90 mmHg
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Bispebjerg Hospital | Copenhagen | Denmark | 2200 |
Sponsors and Collaborators
- Copenhagen University Hospital, Hvidovre
- Bispebjerg Hospital
Investigators
- Study Chair: Jens Hove, MD, PhD, Copenhagen University Hospital Amager-Hvidovre Department of Cardiology
- Principal Investigator: Johannes Grand, MD, PhD, Copenhagen University Hospital Amager-Hvidovre Department of Cardiology
- Study Director: Ida Taraldsen, MD, Copenhagen University Hospital Amager-Hvidovre Department of Cardiology
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- REDOX