Administrative information
Title {1} | Protocol for TRAUMADORNASE: a prospective, randomised, multicentre, double-blinded, placebo-controlled clinical trial of aerosolized dornase alfa to reduce the incidence of moderate to severe hypoxemia in ventilated trauma patients |
Trial registration {2a and 2b} | ClinicalTrials.gov NCT03368092 |
Protocol version {3} | 8.0, November 13, 2018 |
Funding {4} | Aerogen (Ireland) will provide nebulizers to study centres at an estimated value of 28k€. After validation from its Scientific Committee, the TRAUMADORNASE study is supported by a 300k€ grant from the French Ministry of Health (PHRCI-2017-S09). |
Author details {5a} | 1 Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d’Anesthésie-Réanimation Chirurgicale, 1 Avenue Molière, 67098 Strasbourg, France. 2 Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), EA3072, 4 Rue Kirschleger, 67085 Strasbourg, France. 3 Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d’Immunologie et d’Hématologie, 4 rue Kirschleger, 67085 Strasbourg Cedex, France. 4 Sorbonne Universités, UPMC Université Paris 06, INSERM UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie Réanimation, 47-83 Boulevard de l’Hôpital 75651 Paris Cedex 13, France. 5 CHRU Nancy, Hôpital Central, Service d’Anesthésie-Réanimation, 29 Avenue de Lattre de Tassigny, 54000 Nancy, France. 6 CHR Metz-Thionville – Site de Mercy, Service de Réanimation Polyvalente, 1 Allée du Château, 57350 Ars Laqueney, France 7 Groupe Hospitalier de la Région de Mulhouse et Sud Alsace (GHRMSA), Pôle d’Anesthésie-Réanimation, 20 rue du Dr Laennec, 68051, Mulhouse Cedex 1, France. 8 Hôpital Louis Pasteur, Service d’Anesthésie-Réanimation Pôle 2, 39 Avenue de la Liberté, 68024 Colmar Cedex, France. 9 CHU de Reims, Hôpital Maison Blanche, Réanimation Chirurgicale et Traumatologique – SAMU 51, 45 rue Cognacq-Jay 51092, Reims, France. 10 Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Laboratoire Central d’Immunologie, 1 Place de l’Hôpital 67091 Strasbourg Cedex, France. 11 Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Laboratoire d’ImmunoRhumatologie Moléculaire, INSERM UMR_S 1109, 4 rue Kirschleger, 67085 Strasbourg Cedex, France. 12 Hôpitaux Universitaires de Strasbourg, Hôpital Civil, Pôle Santé Publique, Groupe Méthode en Recherche Clinique (GMRC), 1 Place de l’Hôpital, 67091 Strasbourg Cedex, France. 13 Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Physiologie et d’Explorations Fonctionnelles, 1 Place de l’Hôpital 67091 Strasbourg Cedex, France. |
Name and contact information for the trial sponsor {5b} | French Ministry of Health, GIRCI Est, Ms Nathalie PORTIER, CHU de Dijon, 14, rue Paul Gaffarel, BP 77908, 21079 Dijon Cedex, France |
Role of sponsor {5c} | Funders will have no role in the study’s design, collection, management, analysis, interpretation of data, writing of the report, and the decision to submit the report for publication. |
Introduction
Background and rationale {6a}
Pathophysiology of trauma-associated hypoxaemia and acute respiratory distress syndrome
Objectives {7}
Primary objective
Secondary objectives
Trial design {8}
Methods: participants, interventions and outcomes
Study setting {9}
Eligibility criteria {10}
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Adult patient (> 18 years old) of either sex affiliated to the National Health Service
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Severe trauma patient (either blunt or penetrating) with ISS [12] > 15
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Under mechanical ventilation for an expected duration > 48 h
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Admitted to the ICU
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Signed informed consent from the patient or the patient’s relative or emergency consent procedure
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Patient equipped with an indwelling arterial catheter
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Negative pregnancy test in women of childbearing age
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Pregnancy or breast-feeding
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Opposition from the patient or his/her relatives
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Protected major (Guardianship)
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Contraindication to the use of dornase alfa
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Known intolerance to dornase alfa
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Patient whose life expectancy is less than 24 h, according to the treating physician
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“Do not resuscitate” order
Who will take informed consent? {26a}
Additional consent provisions for collection and use of participant data and biological specimens {26b}
Interventions
Explanation for the choice of comparators {6b}
Intervention description {11a}
Ancillary mechanistic study
Criteria for discontinuing or modifying allocated interventions {11b}
Strategies to improve adherence to interventions {11c}
Relevant concomitant care permitted or prohibited during the trial {11d}
Standardization of respiratory care
Provisions for post-trial care {30}
Outcomes {12}
Primary endpoint
Secondary endpoints
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Static lung compliance (ml/cmH2O) (measured at least once daily at 8:00 a.m. during the first 7 days)
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Duration of mechanical ventilation (h) from ICU admission to first extubation success (> 48 h without reintubation)
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Length of ICU stay (h)
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Length of stay in the hospital (days)
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Incidence of multi-organ failure (a SOFA score of 3 or more in at least two organ systems [49]), assessed daily during the first 7 days
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Mortality on day 30
Participant timeline {13}
Visit | |||||
---|---|---|---|---|---|
Information | Enrolment | Allocation, visit 0 | Post-allocation, visits 1–7 | Close-out | |
Timepoint | Day 0 | Day 0 | Day 0 | Days 1–7 | Day 30 |
Location | Hospital | Hospital | Hospital | Hospital | Hospital |
Next of kin information | X* | X* | X | ||
Signed informed consent | X* | ||||
Plasma βHCG assay | X(*) | ||||
Eligibility criteria check | X* | X* | X* | ||
Randomization | X* | ||||
Study drug administration | X*d | X*d | |||
Clinical examinationa | X | X | X | ||
Diagnostic testsb | X | X | X | ||
Blood assayc | X* | X* | |||
Adverse effect recording | X* | X* | X* | X* | |
Concomitant medications | X | X | X | X |
Sample size {14}
Recruitment {15}
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Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre (150 severe trauma patients per year)
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Hôpitaux de Colmar, Hôpital Louis Pasteur (50 severe trauma patients per year)
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Centre Hospitalo-Universitaire de Reims, Hôpital Maison Blanche (150 severe trauma patients per year)
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Centre Hospitalier Régional Metz-Thionville, Hôpital de Mercy (50 severe trauma patients per year)
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Groupe Hospitalier de la Région de Mulhouse et Sud-Alsace, Hôpital du Moenchsberg—Emile Muller (50 severe trauma patients per year)
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Centre Hospitalier Régional Universitaire de Nancy, Hôpital Central (220 severe trauma patients per year)
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Assistance Publique—Hôpitaux de Paris, Hôpital Universitaire Pitié Salpêtrière—Charles Foix (500 severe trauma patients per year)
Assignment of interventions: allocation
Sequence generation {16a}
Concealment mechanism {16b}
Implementation {16c}
Assignment of interventions: blinding
Who will be blinded {17a}
Procedure for unblinding if needed {17b}
Data collection and management
Plans for assessment and collection of outcomes {18a}
Plans to promote participant retention and complete follow-up {18b}
Data management {19}
Confidentiality {27}
Plans for collection, laboratory evaluation and storage of biological specimens for genetic or molecular analysis in this trial/future use {33}
Statistical methods
Statistical methods for primary and secondary outcomes {20a}
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α0 is a grand mean, with mean 0 normal prior (the variance in this normal is 6, corresponding to a low informative prior)
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I(gi = 1) is a dummy covariate coded for the group of subject i (1 for the dornase alpha group and 0 for the placebo group) — the prior on the parameter of this covariate is the same normal as that for the grand mean
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βi is a (random) subject effect, on which is assumed a normal prior with mean 0 and low variance (e.g. 10)
Interim analyses {21b}
Methods for additional analyses (e.g. subgroup analyses) {20b}
Methods in analysis to handle protocol non-adherence and any statistical methods to handle missing data {20c}
Plans to give access to the full protocol, participant-level data and statistical code {31c}
Oversight and monitoring
Composition of the coordinating centre and trial steering committee {5d}
Composition of the data monitoring committee, its role and reporting structure {21a}
Adverse event reporting and harms {22}
Frequency and plans for auditing trial conduct {23}
Plans for communicating important protocol amendments to relevant parties (e.g. trial participants, ethical committees) {25}
Dissemination plans {31a}
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Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work
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Drafting the work or revising it critically for important intellectual content
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Final approval of the version to be published
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Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved