Comparison of Lormetazepam and Midazolam Used as Sedatives for Patients That Require Intensive Care
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 入组人数
- 84
- 试验地点
- 3
- 主要终点
- Controllability of sedation
研究概览
简要总结
A goal directed , demand-driven administration of sedative drugs is an integral part of every intensive care treatment. During long-term application of sedatives, Midazolam is the most commonly used sedative in Europe.
One major objective is the problem of oversedation and agitation during an intensive care treatment due to the lack of controllability of available substances.
The Love-Mi RCT investigates the clinical controllability of Midazolam versus the newly available intravenous drug Lormetazepam.
详细描述
Midazolam is almost exclusively metabolized intrahepatically. The methyl-group at position 1 of the imidazole ring is oxidized by liver enzymes. The product is a-OH-midazolam. This reaction is catalyzed by a p450-dependent oxidase in the liver.
Active a-OH-midazolam is inactivated by a biotransformation type II reaction after conjugation. The water soluble, conjugated midazolam can be excreted by the kidney.
During an intensive care treatment, the p450 dependent metabolization is known to be a "bottleneck of elimination" as many drugs are inactivated by this pathway.
As the phase II (glucuronidation) is non-saturable in practice - the phase I reaction limits the metabolic capacity. This leads to unpredictable prolongation of midazolam effects.
In contrast, Lormetazepam is glucuronized directly at its OH-group during a phase II reaction. Since the glucuronidation is non-saturable, Lormetazepam is metabolized with nearly constant kinetics even if repeatedly administered.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Mechanically ventilated ICU patients with the need for sedatives to achieve or maintain the intended target-RASS (surgical/ nonsurgical).
- •Age ≥ 18 years
- •Patients who are incapable of giving consent at study inclusion: Written informed consent by patient's legal representative or an independent medical consultant, patients give informed consent subsequent if they are capable.
- •Patients who are able to give informed consent at study inclusion: Written informed consent by patients for planned postoperative prolonged ventilatory support who undergo heart surgery
- •Consensable patients for inclusion: with necessary intubation with analgosedation
排除标准
- •Any bolus administration of benzodiazepines until 72hrs before inclusion (except from premedication due to anaesthesia).
- •Continuous administration of benzodiazepines within the last 7 days before start of study drug application
- •Titration phase: No way that a target RASS between -3 and 0 can be determined by the attending physician
- •Known drug intolerance or allergy against lormetazepam, midazolam or one of the additional components.
- •Addictive disorder
- •Increased intracranial pressure
- •Acute intoxication with alcohol, analgesics, sedatives, antipsychotics (neuroleptics, anti-depressives, lithium).
- •Patients with cerebrale Pathology, which changes the controllability of sedation or die consciousness (e.g. patients known mental retardation due to syndromatic disorders or an infantile brain damage)
- •Patients with a suspected or secured hypoxic brain damage
- •Patients with intracranial surgery during actual hospital care
- •Tetraplegic patients
- •Myasthenia Gravis
- •Cerebellar or spinal Ataxia
- •Moribund patients with an expected lifespan of less than 24 hours.
- •Sickle cell anaemia
- •Thallassemia
- •Enzyme related disorders that are associated with a severe decreased activity of UDP-glucoronyltransferase (e.g. M. Crigler- Najjar)
- •Chronic liver insufficiency CHILD C with MELD Score > 17 before access to intensive care unit
- •Diagnosed propofol intolerance/anamnestic propofol infusion Syndrome
- •Known depression/suicidality
- •Pregnancy (positive beta-HCG test from urine or positive beta-HCG laboratory test from serum (in anuric patients the serum beta-HCG test is obliged) or lactation
- •Woman of child-bearing potential who are not using a highly effective contraception (Pearl - Index <1) until 3 months after study inclusion and during this trial
- •Referral following an order of official authorities (court order or administrative decision) according to German Drug Law (AMG)
- •Participation in clinical trials according to the German Drug Law (AMG) 30 days to and during the study
- •Local staff
研究组 & 干预措施
Midazolam
The patient is treated on ICU not longer than 2 days. Dosage requirements according to Summary of product characteristics (Midazolam-ratiopharm®, Midazolam-hameln®).
干预措施: Midazolam (Drug)
Lormetazepam
The patient is treated on ICU not longer than 2 days. Dosage requirements according to Summary of product characteristics (Sedalam®).
干预措施: Lormetazepam (Drug)
结局指标
主要结局
Controllability of sedation
时间窗: Up to 50 hours
Controllability of sedation is defined as the percentage share of measures where the actual depth of sedation (measured with the Richmond Agitation and Sedation Scale) (RASS)) matches the target depths of sedation. The individual sedation target is defined by the attending physician. . It will be measured until 5 days after terminationduring administration of study drug until 2 hours after its termination.
次要结局
- Length of intensive care unit stay(During intensive care unit stay, an average of 14 days)
- Deviation from target Richmond agitation sedation scale (RASS)(Up to 8 days)
- Bedside measurement of Acetylcholinesterase activity (U/gHb)(Up to 8 days)
- Pain-Scores(Up to 28 days)
- SOFA (Sequential Organ Failure Assessment)(Up to 8 days)
- Concurrent medication for Analgesia and Sedation(Up to 8 days)
- Delirium-screening-Instruments(Up to 28 days)
- Mortality(Up to 90 days)
- Length of hospital stay(During hospital stay, an average of 28 days)
- Follow-up treatment regarding Patient- Documentation-Management-System(During hospital stay, an average of 28 days)
- Number of changes in target Richmond agitation sedation scale (RASS)(Up to 56 hours)
- Wake-up-time(Up to 8 days)
- Quality of Life(Up to 90 days)
- Posttraumatic stress disorder(Up to 90 days)
- micro ribonucleic acid (rna)(Up to 24 hours)
- Duration of mechanical ventilation and weaning from mechanical ventilation(Up to 8 days)
- Length of sedation(Up to 56 hours)
- Cognition 1(Up to 28 days)
- Depth of sedation 2(Up to 3 days)
- Pain threshold measurement(Up to 3 days)
- Anxiety-Score(Up to 28 days)
- Cognition 2(Up to 90 days)
- Organ dysfunctions(Up to 8 days)
- Depth of sedation 1(During the operation)
- Photomotor reflex(Up to 8 days)
研究者
Claudia Spies
Univ.-Prof. Dr. med. C. Spies
Charite University, Berlin, Germany