HOT HMV 2: A Phase 4 Study

  • STATUS
    Recruiting
  • participants needed
    200
  • sponsor
    Guy's and St Thomas' NHS Foundation Trust
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Updated on 16 February 2024
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pulmonary disease
mechanical ventilation
carbon dioxide
non-invasive ventilation
acute exacerbation of chronic obstructive pulmonary disease
acute exacerbation of copd

Summary

Smoking related lung disease or Chronic Obstructive Pulmonary Disease (COPD) is characterised by periods of worsening symptoms termed exacerbations. In some patients these may be severe enough to require hospitalisation and support for their breathing. Patients who suffer a severe exacerbation requiring breathing support using mask ventilation (also termed non-invasive ventilation, NIV) have a high chance of being readmitted to hospital in the following 12 months. Recent evidence suggests that the provision of a breathing machine at home (home mechanical ventilation, HMV) may reduce the risk of readmission to hospital in selected patients.

Morbidity and mortality in the 12 months following a life-threatening exacerbation of COPD remain high. Recent data from the Lane Fox Clinical Respiratory Physiology Research Centre supports the addition of home non-invasive ventilation to standard care to improve admission-free survival in patients with persistent hypercapnia following a decompensated exacerbation of COPD.

The study is designed to evaluate the clinical implementation of the delivery of home non-invasive ventilation in COPD patients with persistent hypercapnia following an acute exacerbation of COPD to validate that the clinical benefit derived from the HOT-HMV trial is maintained when the home non-invasive ventilation is implemented into routine clinical practice.

Description

Following publication of the home oxygen therapy-home mechanical ventilation (HOT-HMV) trial, the purpose of this study is to evaluate the clinical service delivery of home non-invasive ventilation (NIV) therapy in patients who have recently undergone, and recovered, from a life-threatening exacerbation of COPD.

This prospective cohort observational study is designed to evaluate the clinical implementation of the delivery of home non-invasive ventilation in COPD patients with persistent hypercapnia following an acute exacerbation of COPD to validate that the clinical benefit demonstrated by the HOT-HMV trial is maintained when the home non-invasive ventilation is incorporated into routine clinical practice.

Patients who have an admission to hospital with an acute exacerbation of COPD requiring non-invasive ventilation will be referred for assessment. Eligible patients will be referred by the critical care or appropriate respiratory team to a monthly assessment clinic for assessment of chronic hypercapnia. The total UK sample size will be 200 participants. St Thomas' critical care unit managed between 80-100 patients per year with non-invasive ventilation for life threatening exacerbation of COPD. This study will run over 4 years; therefore it is anticipated that 200 patients will be enrolled into the trial over this period. Patients will also be referred from peripheral hospitals to the Lane Fox Unit as a regional centre for home ventilation.

Details
Condition COPD Exacerbation
Age 18years - 100years
Treatment Observational Group
Clinical Study IdentifierNCT04272879
SponsorGuy's and St Thomas' NHS Foundation Trust
Last Modified on16 February 2024

Eligibility

 Yes No Not Sure

Inclusion Criteria

Patient suspected or with proven diagnosis of COPD
Admission to hospital with life-threatening exacerbation of COPD requiring acute NIV (at admission evidence of decompensated Chronic Respiratory Insufficiencies (PaCO2 > 6kPa, pH <7.35)
Arterial partial pressure of carbon dioxide (PaCO2) > 6kPa at discharge from hospital
Discharge from hospital without combined home non-invasive ventilation and home oxygen therapy
Patient willing to consider home non-invasive ventilation in addition to home oxygen therapy
Patient suitable for home oxygen therapy (appropriate risk assessment)

Exclusion Criteria

Patient already established on home non-invasive ventilation and home oxygen therapy
Patient unable to support home non-invasive ventilation e.g. unable to apply mask, lacking social support
Patient on palliative care pathway
Patient outside of usual catchment area for Lane Fox Respiratory Service
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