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    Clinical Trial Results:
    Multicentric, comparative, randomized, open study comparing an early post-operative prophylactic non-invasive ventilation (NIV) to standard post-operative care in patients at high-risk of respiratory complications according to ARISCAT preoperative scoring system whose surgery is performed under general or loco-regional anesthesia (ANTICIPUSC).

    Summary
    EudraCT number
    2017-001011-36
    Trial protocol
    FR  
    Global end of trial date
    16 Oct 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    03 Dec 2021
    First version publication date
    03 Dec 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ICO-A-2016-04
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03629431
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    INSTITUT DE CANCEROLOGIE DE L'OUEST
    Sponsor organisation address
    INSTITUT DE CANCEROLOGIE DE L'OUEST 15 R ANDRE BOCQUEL 49055 ANGERS CEDEX 02, ANGERS 02, France, 49055
    Public contact
    DRCI , INSTITUT DE CANCEROLOGIE DE L'OUEST, 33 240 67 97 47, promotionrc@ico.unicancer.fr
    Scientific contact
    DRCI , INSTITUT DE CANCEROLOGIE DE L'OUEST, 0241352700 240 67 97 47, promotionrc@ico.unicancer.fr
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    23 Nov 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    16 Oct 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    16 Oct 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To compare the efficacy of a preventive non-invasive ventilation to standard care On the incidence of postoperative pulmonary complications of acute respiratory failure type, within 7 days post-operative in intra-hospital, in patients at high risk according to ARISCAT scoring system.
    Protection of trial subjects
    In order to ensure the protection of the rights and safety of trial subjects, this clinical trial was performed in compliance with the principles laid down in the declaration of Helsinki, good clinical practice and European regulation.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    03 Nov 2017
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    France: 253
    Worldwide total number of subjects
    253
    EEA total number of subjects
    253
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    226
    From 65 to 84 years
    25
    85 years and over
    2

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Patients eligible for the study will be seen in screening’s visit to check the inclusion and exclusion criteria. 1149 patients assessed for eligibility

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm experimental : prophylactic NIV
    Arm description
    In the intervention treatment arm, all patients were transferred to an intermediate or intensive care unit in order to receive noninvasive ventilation as soon as possible after estuation
    Arm type
    Experimental

    Investigational medicinal product name
    Oxygen
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gas for dispersion for infusion
    Routes of administration
    Inhalation use
    Dosage and administration details
    Noninvasive ventilation was started with an inspiratory pressure support of 5 to 8 cmH2O, and the level was increased progressively by 2 to 3 cmH2O until respiratory comfort was obtained with a tidal volume of 6 to 8 mL/kg of predicted body weight 27 and a respiratory rate lower than 30/min. Positive end-expiratory pressure (PEEP) was started at 5 cmH2O and increased as needed to a maximum of 10 cm H2O. The fraction of inspired oxygen (FiO2) and PEEP were titrated to obtain a SpO2 of > 92% or a PaO2 of > 70 mmHg. Total airway pressure (PEEP + inspiratory pressure support) was maintained at less than 20 cmH2O to avoid gastric distention or anastomotic leakage 19

    Arm title
    Arm control : standard care
    Arm description
    All patients received therapeutic measures necessary for optimal care, including perioperative analgesia, chest physiotherapy, and bronchodilator administration as needed.
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Arm experimental : prophylactic NIV Arm control : standard care
    Started
    125
    128
    Completed
    125
    128

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    253 253
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    226 226
        From 65-84 years
    25 25
        85 years and over
    2 2
    Age continuous
    Units: years
        geometric mean (standard deviation)
    67.4 ( 10.5 ) -
    Gender categorical
    Units: Subjects
        Female
    50 50
        Male
    203 203

    End points

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    End points reporting groups
    Reporting group title
    Arm experimental : prophylactic NIV
    Reporting group description
    In the intervention treatment arm, all patients were transferred to an intermediate or intensive care unit in order to receive noninvasive ventilation as soon as possible after estuation

    Reporting group title
    Arm control : standard care
    Reporting group description
    All patients received therapeutic measures necessary for optimal care, including perioperative analgesia, chest physiotherapy, and bronchodilator administration as needed.

    Primary: Acute respiratory failure within the first 7 days following surgery

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    End point title
    Acute respiratory failure within the first 7 days following surgery
    End point description
    End point type
    Primary
    End point timeframe
    7 days
    End point values
    Arm experimental : prophylactic NIV Arm control : standard care
    Number of subjects analysed
    125
    128
    Units: patients
    30
    35
    Statistical analysis title
    Efficacy results
    Comparison groups
    Arm experimental : prophylactic NIV v Arm control : standard care
    Number of subjects included in analysis
    253
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.543
    Method
    Chi-squared
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From signing the consentment until 7 days post surgery
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20
    Reporting groups
    Reporting group title
    Arm experimental : prophylactic NIV
    Reporting group description
    -

    Reporting group title
    Arm control : standard care
    Reporting group description
    -

    Serious adverse events
    Arm experimental : prophylactic NIV Arm control : standard care
    Total subjects affected by serious adverse events
         subjects affected / exposed
    25 / 125 (20.00%)
    23 / 128 (17.97%)
         number of deaths (all causes)
    3
    2
         number of deaths resulting from adverse events
    3
    2
    Injury, poisoning and procedural complications
    Air embolism
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    post procedural cardiogenic shock
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Post procedural haemorrhage
         subjects affected / exposed
    4 / 125 (3.20%)
    3 / 128 (2.34%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Post procedural stroke
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Splenic rupture
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Transient ischaemic attack
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhagic stroke
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intestinal ischaemia
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    1 / 125 (0.80%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 1
    Pericardial effusion
         subjects affected / exposed
    1 / 125 (0.80%)
    3 / 128 (2.34%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrioventricular block
         subjects affected / exposed
    0 / 125 (0.00%)
    2 / 128 (1.56%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac tamponade
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pericardial haemorrhage
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sinus node dysfunction
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Seizure
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Ileus
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    necrositing oesophagitis
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peritonitis
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumoperitoneum
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subileus
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Bronchial fistula
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchial obstruction
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia aspiration
         subjects affected / exposed
    2 / 125 (1.60%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis acute
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Hemothorax
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    2 / 125 (1.60%)
    2 / 128 (1.56%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Mediastinitis
         subjects affected / exposed
    2 / 125 (1.60%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 125 (0.80%)
    0 / 128 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Food intolerance
         subjects affected / exposed
    0 / 125 (0.00%)
    1 / 128 (0.78%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Arm experimental : prophylactic NIV Arm control : standard care
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    125 / 125 (100.00%)
    128 / 128 (100.00%)
    Injury, poisoning and procedural complications
    Postopoperative pulmonary complication
         subjects affected / exposed
    125 / 125 (100.00%)
    128 / 128 (100.00%)
         occurrences all number
    1
    1
    Surgical and medical procedures
    Chirurgical complication
         subjects affected / exposed
    7 / 125 (5.60%)
    17 / 128 (13.28%)
         occurrences all number
    0
    0
    Cardiac disorders
    Cardiovascular disorder
         subjects affected / exposed
    67 / 125 (53.60%)
    74 / 128 (57.81%)
         occurrences all number
    0
    0
    General disorders and administration site conditions
    Multiple organ failure
         subjects affected / exposed
    37 / 125 (29.60%)
    52 / 128 (40.63%)
         occurrences all number
    0
    0
    Complications of non invasive ventilation
         subjects affected / exposed
    69 / 125 (55.20%)
    33 / 128 (25.78%)
         occurrences all number
    0
    0
    Gastrointestinal disorders
    Digestive disorders
         subjects affected / exposed
    58 / 125 (46.40%)
    55 / 128 (42.97%)
         occurrences all number
    0
    0
    Psychiatric disorders
    psychiatric disorders
         subjects affected / exposed
    28 / 125 (22.40%)
    26 / 128 (20.31%)
         occurrences all number
    0
    0
    Infections and infestations
    Infection
         subjects affected / exposed
    37 / 125 (29.60%)
    55 / 128 (42.97%)
         occurrences all number
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    30 May 2018
    - Updated withdrawal of patient definition
    04 Mar 2019
    - Change the organization of DSMB - Update to the list of investigator(s) - Extend the period of inclusions - Update of pharmacovigilance contact details - Update the regulatory references relating to the General Data Protection Regulations

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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