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PRACTICAL Platform

PRACTICAL (Platform of Randomized Adaptive Clinical Trials in Critical Illness) is a Bayesian adaptive platform randomized clinical trial studying novel interventions to improve outcomes for patients with acute hypoxemic respiratory failure.

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Platform Structure

The PRACTICAL platform is designed to function as a research “pipeline” to facilitate seamless and efficient evaluation of interventions for hypoxemic respiratory failure, from preliminary trials focused on mechanistic endpoints to full-scale definitive clinical trials.

Interventions will be studied at various phases of investigation, including pilot and feasibility trials, preliminary trials of physiological and biological effect, and definitive trials evaluating treatment effect on patient-centered outcomes.

Our Goals

PRACTICAL is a Bayesian, adaptive, multi-factorial, randomized, registry-embedded platform trial focused on hospitalized patients with acute hypoxemic respiratory failure.

  1. To develop a new, more efficient approach to discovering effective treatments for respiratory failure
  2. To improve survival and quality of life for patients with respiratory failure around the world
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The platform enrolls patients with acute hypoxemic respiratory failure in four different severity states, defined as:

  1. State One

    Not intubated but require non-invasive oxygen/respiratory support for hypoxemia

  2. State Two

    Intubated and have low respiratory system elastance (≤2.5 cm H2O/(ml/kg PBW))

  3. State Three

    Intubated and have high respiratory system elastance (>2.5 cm H2O/(ml/kg PBW))

  4. State Four

    Receiving extracorporeal life support

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Clinical Strategies

Our domains test the effect of various interventional strategies on disease mechanisms and patient outcomes in patients requiring invasive or non-invasive respiratory support for acute hypoxemic respiratory failure.

  1. Invasive ventilation strategies comparing the effects of best conventional mechanical ventilation, driving pressure-limited ventilation, and a lung/diaphragm protective approach to ventilation and sedation
  2. Extracorporeal life support strategies evaluating the use of ECLS to reduce ventilator-associated lung injury and complications of sedation and immobilization.
  3. Corticosteroids to accelerate recovery at early and late phases of acute Hypoxemic respiratory failure
  4. Nebulized furosemide, in addition to usual care will be evaluated as an adjunctive treatment in patients with hypoxemic respiratory failure requiring either invasive or non-invasive mechanical ventilation as to its efficacy for improvement of patient centered outcomes.
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Trial Team

The PRACTICAL platform team includes doctors, respiratory therapists, nurses, pharmacists, and scientists from around the world with internationally recognized expertise in treating respiratory failure.

We study the causes and outcomes of respiratory failure with the goal of developing new treatments to improve survival and quality of life for patients who develop respiratory failure. The platform is overseen by a steering committee of experienced clinical trialists.

The committee is co-chaired by Dr. Ewan Goligher and Dr. Eddy Fan of the University Health Network in Toronto, Canada.

Each domain is led by a different team of investigators. PRACTICAL represents a global collaboration to accelerate discovery and innovation to improve care in the ICU.

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