A Prospective, Multi-centre, Randomised, Double-blind Comparison of Intravenous Dexmedetomidine With Propofol for Continuous Sedation of Ventilated Patients in Intensive Care Unit
Overview
- Phase
- Phase 3
- Intervention
- Dexmedetomidine
- Conditions
- Continuous Sedation in Initially Sedated Adults in ICU
- Sponsor
- Orion Corporation, Orion Pharma
- Enrollment
- 500
- Locations
- 40
- Primary Endpoint
- Depth of sedation using the RASS. The target RASS range (target depth of sedation) should be 0 to -3 for a patient to be included in the study. The target may be amended during the study treatment, if clinically required.
- Status
- Completed
- Last Updated
- 15 years ago
Overview
Brief Summary
Patients in the ICU who need help with their breathing are put onto a machine called a ventilator and are also given a medicine, called a sedative, which helps them to sleep and makes them more comfortable. Propofol is a sedative that is routinely used for these purposes.
For most patients the aim of sedation is to make them sleepy but still able to respond to nursing staff (light sedation).
Dexmedetomidine is a new sedative for use in intensive care and in this clinical study,dexmedetomidine is compared to propofol. It is thought that dexmedetomidine might be slightly better at allowing patients to be sleepy but still respond to people around them. It also does not appear to affect patient's breathing. The purpose of this study is to test whether dexmedetomidine really does have these advantages compared to propofol.
In this study, we hope to show that: dexmedetomidine is at least as good as propofol in helping patients to sleep better and making them more comfortable, and that they are able to communicate and cooperate better with the staff treating them, and that patients treated with dexmedetomidine require a shorter time on the ventilator than those treated with propofol.
Detailed Description
This is a phase III, multi-centre, prospective, randomised, double-blind, double-dummy, active comparator study. The study consists of three periods: screening, double-dummy treatment and follow-up period. All patients admitted to ICU will be pre-screened according to inclusion and exclusion criteria prior to informed consent using available clinical data. Informed consent, screening and randomisation procedures should be completed within 72 hours from the time of admission to ICU and within 48 hours from starting continuous sedation. Eligible study subjects requiring light to moderate sedation (Richmond Agitation-Sedation Scale \[RASS\] = 0 to -3) will be randomised to either continue on propofol or switch to dexmedetomidine. Patients should not have received any other continuously or regularly administered sedative agent than propofol during the last 12 hours except for opioid analgesics. Study treatments will be titrated to achieve an individually targeted sedation range determined on a daily basis. Rescue treatment (i.e. midazolam boli) may be given if needed to achieve the target depth of sedation. Continued need for sedation will be assessed at a daily sedation stop, conducted at the same time each day. First sedation stop may be 12-36 hours from randomisation, depending on the time of day the study subject is randomised. The duration of study treatment is limited to a maximum of 14 days from randomisation. Following withdrawal of sedation, study subjects will be monitored for 48 hours and contacted by telephone 31 and 45 days after randomisation.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age more than 18 years
- •Clinical need for sedation of an initially intubated (or tracheotomised) and ventilated (with inspiratory assistance) patient
- •Prescribed light to moderate sedation (target RASS = 0 to -3) using propofol
- •Patients should be randomised within 72 hours from ICU admission and within 48 hours of commencing continuous sedation in the ICU
- •Patients should have an expected requirement for sedation more than 24 hours from time of randomisation
- •Written informed consent must be obtained according to local regulations before starting any study procedures other than pre-screening
Exclusion Criteria
- •Acute severe intracranial or spinal neurological disorder due to vascular causes, infection, intracranial expansion or injury
- •Uncompensated acute circulatory failure at time of randomisation (severe hypotension with mean arterial pressure \[MAP\] \< 55 mmHg despite volume and pressors)
- •Severe bradycardia (heart rate \[HR\] \< 50 beats/min)
- •AV-conduction block II-III (unless pacemaker installed)
- •Severe hepatic impairment (bilirubin \> 101 µmol/l)
- •Need for muscle relaxation at the time of randomisation (may only be used for intubation and initial stabilization)
- •Loss of hearing or vision, or any other condition which would significantly interfere with the collection of study data
- •Burn injuries requiring regular anaesthesia or surgery
- •Use of centrally acting α2 agonists or antagonists at the time of randomisation, notably clonidine
- •Patients who have or are expected to have treatment withdrawn or withheld due to poor prognosis
Arms & Interventions
1
Dexmedetomidine
Intervention: Dexmedetomidine
2
Propofol
Intervention: Propofol
Outcomes
Primary Outcomes
Depth of sedation using the RASS. The target RASS range (target depth of sedation) should be 0 to -3 for a patient to be included in the study. The target may be amended during the study treatment, if clinically required.
Time Frame: 2 hourly and before each rescue treatment dose during the treatment period and the 48-hour follow-up
Duration of mechanical ventilation
Time Frame: Start and stop times of mechanical ventilation while the patient is treated in the ICU
Secondary Outcomes
- Nurse's assessment of subject communication with visual analogue scales (VAS)(At the end of each nursing shift during study treatment and 48 h follow-up period in the ICU)
- Length of ICU stay(Admission and discharge dates and times during the current ICU treatment period)