UK ANDROMEDA-Shock-2 RCT
- Conditions
- Septic Shock
- Interventions
- Procedure: Personalised fluid and haemodynamic resuscitation
- Registration Number
- NCT06366854
- Lead Sponsor
- Guy's and St Thomas' NHS Foundation Trust
- Brief Summary
The purpose of the trial is to test if a strategy of resuscitation guided by capillary refill time and individualised clinical hemodynamic phenotyping can improve important clinical outcomes within 28 days in septic shock patients compared to usual care.
- Detailed Description
Septic shock is a life-threatening condition caused by a severe infection. It can rapidly cause multi-organ failure and is associated with a high risk of dying. Patients with septic shock need emergency treatment with intravenous fluids, antibiotics and medications to improve blood supply to all organs. However, it is clear that giving too much fluid is harmful and giving not enough fluid can make organ failure worse, too. International guidelines exist but there is still a lot of variation in how doctors apply the guideline. Further, it is likely that a "one-size-fits-all" approach does not help all patients.
Previously, the Andromeda-Shock 1 trial showed that resuscitation guided by regular monitoring of skin perfusion was associated with a lower risk of dying than resuscitation guided by regular blood tests. The UK Andromeda-Shock-2 RCT builds on this. The aim is to investigate whether an individualised approach based on monitoring of skin perfusion combined with individualised treatment of the blood pressure and circulation for 6 hours is better for patients with septic shock and reduces the risk of organ failure and dying compared to usual care.
During the study period, the investigators will also take a total of 40ml of blood and 60ml of urine for special kidney tests to evaluate kidney health and recovery of kidney function.
After the study has finished, the investigators plan to share fully anonymised results with the investigators of the international Andromeda Shock 2 trial to get as much information as possible to answer the research question and help patients in future.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 25
Consecutive adult patients (≥ 18 years) with septic shock defined by Sepsis-3 consensus criteria. (ie septic shock defined as suspected or confirmed infection, hyperlactatemia and noradrenaline requirement, after a fluid load of at least 1000mL in 1 hour)
Any of the following criteria preclude participation to the trial:
- More than 4 hours since septic shock diagnosis,
- Surgery or acute renal replacement therapy anticipated to start during the 6h intervention period
- Active bleeding,
- Child B-C Cirrhosis
- Underlying disease process with a life expectancy <90 days
- Attending clinician deems aggressive resuscitation unsuitable
- Refractory shock (high risk of death within 24h)
- Pregnancy
- Concomitant severe acute respiratory distress syndrome
- Capillary refill time cannot be accurately assessed
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description control group Personalised fluid and haemodynamic resuscitation Management guided by clinical team Intervention Personalised fluid and haemodynamic resuscitation Management consists of a strategy that targets capillary refill time and individualised haemodynamic parameters, using vasopressors, fluids as guided by fluid responsiveness tests and inotropic support as guided by echocardiography.
- Primary Outcome Measures
Name Time Method organ support 28 days time to cessation of vital organ support
hospital mortality 28 days number of patients who died in hospital
length of stay 28 days length of stay in hospital
- Secondary Outcome Measures
Name Time Method mortality 60 days number of patients who died
length of stay 60 days length of stay in hospital
vital organ support 28 days number of days without vital organ support