A Phase III Single-Blind, Randomized, Placebo Controlled, Clinical Trial to Determine the Safety and Efficacy of Intravenous L-Citrulline Versus Placebo in Children Undergoing Cardiopulmonary Bypass
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 入组人数
- 77
- 试验地点
- 1
- 主要终点
- Duration of postoperative mechanical ventilation in hours compared between treatment groups.
研究概览
简要总结
This clinical trial will determine the safety and effectiveness of intravenous L-citrulline in children undergoing cardiopulmonary bypass during heart surgery. Participants will be randomly assigned to either L-citrulline or a placebo (a substance that has no medicine in it).
Citrulline is a protein building block in the body that can convert into another substance, nitric oxide (NO), which controls blood pressure in the lungs. Increased blood pressure in the lungs can be an important surgical problem; it may also lead to problems following surgery, such as severe high blood pressure in the lungs (pulmonary hypertension), increased time spent on a breathing machine, and a longer stay in the intensive care unit (ICU). The hypothesis of this study is that perioperative supplementation with intravenous citrulline will increase plasma citrulline, arginine and NO metabolites and prevent elevations in the postoperative PVT leading to a decrease in the duration of postoperative invasive mechanical ventilation.
详细描述
Increased pulmonary vascular tone (PVT) can complicate the postoperative course of the following five surgical procedures for congenital heart defects: 1) unrestrictive ventricular septal defect (VSD) repair; 2) atrioventricular septal (AVSD) repair; 3) arterial switch procedure for transposition of the great arteries (TGA); 4) bidirectional Glenn shunt procedure; and 5) Fontan procedure for single ventricle lesions. PVT is partially controlled by NO. Arginine, the precursor to NO, is a product of the urea cycle. Preliminary data have been presented regarding 169 infants and children who have undergone one of six previous surgical procedures. It was found that urea cycle function and plasma arginine levels were significantly decreased in all participants. Furthermore, participants with increased PVT had significantly lower arginine levels compared to participants with normal PVT. Finally, a genetic single nucleotide polymorphism (SNP) in the rate limiting urea cycle enzyme (carbamyl phosphate synthetase I [CPSl T1405N]) appeared to affect postoperative plasma arginine levels and PVT. The hypothesis is that genetic polymorphisms in the rate limiting urea cycle enzyme CPSl, and other important enzymes in the urea cycle, influence the availability of NO precursors. It is further hypothesized that perioperative enhancement of urea cycle function with the key urea cycle intermediate (citrulline) will increase plasma arginine and NO metabolites and prevent elevations in PVT.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- — 至 17 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Undergoing cardiopulmonary bypass surgery with 1 of the following 5 procedures:
- •AVSD repair
- •Bidirectional Glenn
- •Modified Fontan
- •Arterial switch
排除标准
- •Pulmonary artery or vein abnormalities not being addressed surgically
- •Preoperative requirement for mechanical ventilation or intravenous inotrope support
- •Any condition that might interfere with study objectives, as determined by the investigator
研究组 & 干预措施
1
Intravenous L-citrulline
干预措施: L-citrulline (Drug)
2
Placebo of intravenous L-citrulline
干预措施: Placebo of intravenous L-citrulline (Drug)
结局指标
主要结局
Duration of postoperative mechanical ventilation in hours compared between treatment groups.
时间窗: Measured in hours from the end of surgery until extubation
次要结局
- Length of hospitalization(Measured from the day of surgery until discharge from hospital)
- Length and volume of chest tube drainage(Measured in hours from the end of surgery until removal of chest tubes)
- Length of ICU stay(Measured in hours from the end of surgery to discharge from ICU)
- Postoperative intravenous inotrope score(Measured at 48 hours)
- Incidence of increased PVT (defined as a sustained mean pulmonary artery pressure greater than 20 mm Hg for at least 2 hours, measured during the first 48 hours(Measured in hours from the end of surgery until extubation)
- Survival(Measured at 30 days post surgical repair)