Preventive nebulization of mucolytic agents and bronchodilating drugs in invasively ventilated intensive care unit patients (NEBULAE): study protocol for a randomized controlled trial.
BACKGROUND
Preventive nebulization of mucolytic agents and bronchodilating drugs is a strategy aimed at the prevention of sputum plugging, and therefore atelectasis and pneumonia, in intubated and ventilated intensive care unit (ICU) patients. The present trial aims to compare a strategy using the preventive nebulization of acetylcysteine and salbutamol with nebulization on indication in intubated and ventilated ICU patients.


METHODS
The preventive nebulization of mucolytic agents and bronchodilating drugs in invasively ventilated intensive care unit patients (NEBULAE) trial is a national multicenter open-label, two-armed, randomized controlled non-inferiority trial in the Netherlands. Nine hundred and fifty intubated and ventilated ICU patients with an anticipated duration of invasive ventilation of more than 24 hours will be randomly assigned to receive either a strategy consisting of preventive nebulization of acetylcysteine and salbutamol or a strategy consisting of nebulization of acetylcysteine and/or salbutamol on indication. The primary endpoint is the number of ventilator-free days and surviving on day 28. Secondary endpoints include ICU and hospital length of stay, ICU and hospital mortality, the occurrence of predefined pulmonary complications (acute respiratory distress syndrome, pneumonia, large atelectasis and pneumothorax), and the occurrence of predefined side effects of the intervention. Related healthcare costs will be estimated in a cost-benefit and budget-impact analysis.


CONCLUSIONS
The NEBULAE trial is the first randomized controlled trial powered to investigate whether preventive nebulization of acetylcysteine and salbutamol shortens the duration of ventilation in critically ill patients.


BACKGROUND
NCT02159196, registered on 6 June 2014.
Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.m.vanderhoeven@amc.uva.nl.
Sophia M
SM
van der Hoeven
Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.m.binnekade@amc.uva.nl.
Jan M
JM
Binnekade
Clinical Research Unit, Amsterdam, The Netherlands. c.deborgie@amc.uva.nl.
Corianne A J M
CA
de Borgie
Department of Intensive Care, Rijnstate, Arnhem, The Netherlands. FHBosch@rijnstate.nl.
Frank H
FH
Bosch
Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. H.Endeman@olvg.nl.
Henrik
H
Endeman
Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.horn@amc.uva.nl.|Laboratory of Experimental Intensive Care and Anesthesiology (L E I C A), Amsterdam, The Netherlands. j.horn@amc.uva.nl.
Janneke
J
Horn
Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. n.p.juffermans@amc.uva.nl.|Laboratory of Experimental Intensive Care and Anesthesiology (L E I C A), Amsterdam, The Netherlands. n.p.juffermans@amc.uva.nl.
Nicole P
NP
Juffermans
Department of Intensive Care, Amphia Hospital, Breda, Oosterhout and Etten-Leur, The Netherlands. bvandermeer@amphia.nl.|Tias/Tilburg University, Tilburg, The Netherlands. bvandermeer@amphia.nl.
Nardo J M
NJ
van der Meer
Clinical Research Unit, Amsterdam, The Netherlands. m.merkus@amc.uva.nl.
Maruschka P
MP
Merkus
Department of Intensive Care, Antonius Hospital, Nieuwegein, The Netherlands. h.moeniralam@antoniusziekenhuis.nl.
Hazra S
HS
Moeniralam
Department of Intensive Care, Antonius Hospital, Nieuwegein, The Netherlands. bartsilfhout@antoniusziekenhuis.nl.
Bart
B
van Silfhout
Department of Intensive Care, Medical Center Haaglanden and Leidschendam, The Hague, The Netherlands. m.slabbekoorn@mchaaglanden.nl.
Mathilde
M
Slabbekoorn
Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. W.Stilma@olvg.nl.
Willemke
W
Stilma
Department of Intensive Care, Amphia Hospital, Breda, Oosterhout and Etten-Leur, The Netherlands. JWijnhoven@Amphia.nl.
Jan Willem
JW
Wijnhoven
Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. marcus.j.schultz@gmail.com.|Laboratory of Experimental Intensive Care and Anesthesiology (L E I C A), Amsterdam, The Netherlands. marcus.j.schultz@gmail.com.
Marcus J
MJ
Schultz
Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. f.paulus@amc.uva.nl.
Frederique
F
Paulus
D000111:Acetylcysteine / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000280:Administration, Inhalation; D000420:Albuterol / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D004334:Drug Administration Schedule; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005100:Expectorants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay; D009330:Nebulizers and Vaporizers; D009426:Netherlands; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000517:prevention & control; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000517:prevention & control; D012107:Research Design; D012121:Respiration, Artificial / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D005100:Expectorants; D000420:Albuterol; D000111:Acetylcysteine