High Versus Low Target Mean Arterial Pressure in Septic Shock in Critically Ill Cirrhotics

Not Applicable

Completed

• Conditions: Cirrhosis
• Interventions: Other: Low Target Mean Arterial Pressure; Other: High Target Mean Arterial Pressure

• Registration Number: NCT03145168
• Lead Sponsor: Institute of Liver and Biliary Sciences, India

Brief Summary

Study Design:

* A randomized controlled study.

* The study will be conducted on patients admitted to Department of Hepatology from April 2017 to October 2017 at ILBS, New Delhi

* Study group will comprise of patients critically ill cirrhotics with septic shock

All included patients would be randomised to low target MAP group (60-65mm Hg) or high target group (80-85 mm of Hg). Patients older than 18 years of age will be enrolled if they have septic shock that is refractory to fluid resuscitation and if they required vasopressors (norepinephrine or epinephrine or terlipressin) at a minimum infusion rate of 0.1 μg per kilogram per minute. Standard criteria will be considered to define refractoriness to fluids. The target MAP would be maintained for a max. of 5 days or until recovery or shock and or AKI. In the high-target group, a reduction in vasopressor doses to maintain a mean arterial pressure of 65 to 70 mm Hg will be done in case of any of the prespecified serious adverse events that could potentially be related to an increased rate of vasopressor infusion occurred. These events could be: clinically relevant bleeding (i.e., transfusion requirements of at least 2 units of packed red cells), myocardial infarction (defined as typical electrocardiographic changes, with a concomitant increase in troponin, and segmental echocardiographic hypokinesia or akinesia, with the infarction confirmed, when possible, by means of coronary angiography), major ventricular arrhythmia, poorly tolerated supraventricular arrhythmia, mesenteric ischemia, and distal-limb ischemia.

• Septic shock would be defined as clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP\>=65 mm of Hg and having a serum lactate \>2 mmol/L despite adequate volume resuscitation

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2017-04-10
• Study First Submitted QC: 2017-05-08
• Study First Posted: 2017-05-09
• Study Start: 2018-09-19
• Primary Completion: 2021-03-18
• Study Completion: 2021-03-18
• Status Verified: 2022-09
• Last Update Submitted: 2022-09-20
• Last Update Posted: 2022-09-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 150

Inclusion Criteria

• Critically ill cirrhotics with septic shock

Exclusion Criteria

• Patients with age less than 18 years
• Severe known cardiopulmonary disease (structural or valvular heart disease, coronary artery disease, COPD)
• Pregnancy
• Chronic kidney disease on hemodialysis
• Extremely moribund patients with an expected life expectancy of less than 24 hours
• Failure to give informed consent from family members.
• Hemodynamic instability requiring very high dose of vasopressors

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Low target Mean Arterial Pressure	Low Target Mean Arterial Pressure	-
High Target Mean Arterial Pressure	High Target Mean Arterial Pressure	-

Primary Outcome Measures

Name	Time	Method
Survival in both groups	28 days

Secondary Outcome Measures

Name	Time	Method
Incidence of intradialytic hypotension in patients undergoing Renal Replacement Therapy	3 months
Duration of mechanical ventilation	3 months
Reversal of shock in both groups	Day 5
Acute Kidney Injury in both groups.	Day 5
Duration of Intensive Care Unit /Hospital stay	3 months

Trial Locations

Locations (1)

Institute of Liver and Biliary Sciences; 🇮🇳 New Delhi, Delhi, India