Acute Chest Syndrome, Sickle Cell Disease
Conditions
Keywords
Inhaled drug, Acute lung injury, Nitric oxide, Sickle cell
Brief summary
Acute chest syndrome (ACS) is a frequent and potentially life-threatening pulmonary illness. It is a complication of sickle cell disease and is the leading cause of death from this disease in adults. Several pathologic processes are recognized causes of ACS, including infectious diseases, hypoventilation secondary to chest pain, in situ thrombosis and pulmonary fat embolism. Inhaled nitric oxide (iNO) has been shown to be a pulmonary vasodilatator with minimal systemic effects and has also been shown to improve gas exchange in both animal and human acute lung injury (ALI). The combined effects of iNO gas of improving pulmonary ventilation to perfusion matching, reducing alveolar and systemic inflammation, modulate the course of acute chest syndrome, which combine the physiopathology of vaso-occlusive crisis and acute lung injury. We hypothesise inhaled NO will improve oxygenation and clinical outcome of sickle cell disease patients with acute chest syndrome.
Detailed description
Objectives: To compare the outcome and duration of acute chest syndrome (ACS) in patients with sickle cell disease (SCD) treated with iNO to that of similar episodes experienced by patients which receive a placebo. Study design: Bi-center, prospective, randomized, controlled clinical trial * Enrollment: 24 months * Patients will be treated for 72 hours * Patients will be followed for 15 days or until discharged home Sample size: * The study will accrue a maximum of 240 patients * Progress of the trial will be reviewed by an independent data and safety monitoring committee to determine if randomization should stop for safety reasons.
Interventions
DRUGNitric Oxide
NO in inhalation for 3 days
DRUGPlacebo
Placebo in inhalation for 3 days
Sponsors
Mallinckrodt
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with sickle cell disease (Hemoglobin genotypes characterized by standard procedures as homozygous hemoglobin SS, hemoglobin SC, and S beta thalassemia) * Diagnosis of acute chest syndrome based on the presence of fever, dyspnea or chest pain, associated with new pulmonary infiltrates on chest X-ray
Exclusion criteria
* Patient has been hospitalised \< 14 days ago * Patients presenting with clinically diagnosed bacterial infections * Patients who have received an exchange transfusion in the last 30 days or are in a transfusion program. * Current pregnancy or lactation * Patient who is currently enrolled in any other investigational drug study * Previous participation in this study * Any of the following medical conditions: * Immediate need of ventilatory support wih orotracheal intubation * Hemodynamic instability
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percentage of patients with treatment failure | at day 3 |
Secondary
| Measure | Time frame |
|---|---|
| Proportion of hypoxemic patients defined by a PaO2/FiO2 ratio < 300 | at day 3 |
| Variation of pulmonary arterial systolic pressure evaluated by echocardiography | at day 1, day 3 and end of study |
| Length of hospitalisation | from day 0 to day 15 (max) |
| Pain assessment and the cumulative dose of parenteral opioids per body weight | during the first three days and during entire hospitalization |
| Proportion of patients requiring transfusion therapy (simple or exchange) | from day 1 to end of study |
Countries
France
Outcome results
None listed