Bacterial Meningitis Clinical Trial
— IHPOTOTAMOfficial title:
Mild Induced Hypothermia to Treat Severe Community Acquired Meningitis in Adults Admitted to Intensive Care Unit
Bacterial meningitis is a severe infection of the envelope which surrounds the brain. It is
sometimes responsible for a cerebral oedema mattering with a loss of consciousness (coma).
The usual treatment of this affection is based on the antibiotic therapy, anti-inflammatory
drug and resuscitation measures in intensive care setting but the prognosis of comatose
patients remains poor.
Moderate hypothermia (body temperature is downed between 32 and 34°C°) made the proof of its
efficiency in certain cerebral pathologies (notably the cerebral distress after cardiac
arrest or oxygen lack in neonates) but was never evaluated in meningitis. In meningitis
animal studies and in severe traumatic brain injury, moderate hypothermia is able to
diminish cerebral oedema and brain inflammation.
Thus, the objective of this study is to compare two strategies: only usual care or usual
care completed by moderate hypothermia. The body temperature will be lowered between 32 and
34°C by means of a catheter placed in a big vein and connected to a machine in which
circulates a cold liquid, or by means of an external cooling (ice-cold blanket, ice packs
placed on the body). Whatever technique is chosen, the technique is perfectly mastered by
the teams which take charge of the patients. After 48 hours, the technique of hypothermia
will be suspended and body temperature will return passively and gradually to normal.
The investigators believe that moderate hypothermia will improve the prognosis of the most
severe patients.
Status | Terminated |
Enrollment | 98 |
Est. completion date | July 2012 |
Est. primary completion date | February 2012 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
INCLUSION CRITERIA: - Subject is 18 years of age or older - Clinically suspected community-acquired bacterial meningitis (More than 100 white blood cells in CSF and a glucose CSF/Blood ratio of 1/3 or less, or a CSF protein level above 2,2 g/L.) - Presence of micro-organisms on CSF Gram's stain examination - Positive soluble antigen or PCR for S. pneumoniae or N. meningitides - Positive CSF cultures - Score on Glasgow Coma Score < 8 - Patient received appropriate antimicrobial therapy (according to recommendations) - If present, legally acceptable representative has provided written and dated informed consent to participate in the study. EXCLUSION CRITERIA: - Glasgow Coma Score < 8 for more than 12 hours - Patients with HIV positivity: positive cryptococcal antigen in blood or CSF; Cerebral abscess - pregnancy - Subject has been designated as "not full support", "do not resuscitate" or equivalent status which prohibits the use of life supporting interventions thereby limiting options available - Subject admitted for a clinical situation in which induced hypothermia is recommended - Purpura fulminancy, defined as septic shock with extensive necrotizing purpura and disseminated intravascular coagulation. |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
France | Hopital Bichat Claude Bernard | Paris |
Lead Sponsor | Collaborator |
---|---|
Assistance Publique - Hôpitaux de Paris |
France,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Proportion of patients with unfavorable outcome (defined as score on Glasgow outcome Scale < 5) at 3 months after admission. | 3 months | No | |
Secondary | Mortality (assessed on day 14 after admission, day 28, total in-hospital mortality, and at 3 and 6 months) | 6 months | Yes | |
Secondary | ICU length of stay | 6 months | No | |
Secondary | Score on GOS at ICU discharge and 6 months after admission | 6 months | No | |
Secondary | Neurological examination at discharge and 6 months after admission | 6 months | No | |
Secondary | Neuropsychological outcome at 6 months in a subset of centres; patient will be tested with a neuropsychological test battery described previously | 6 months | No | |
Secondary | MRC score on ICU discharge | 3 months | No | |
Secondary | Prevalence of status EPILEPTISIS | 6 months | No | |
Secondary | Prevalence of infections (aspiration pneumonia and nosocomial infections) | 6 months | No | |
Secondary | Potential hypothermia related side effects as cardiac arrhythmia, electrolyte balance, hyperglycemia, bleeding, acute pancreatitis (see definitions further). | 6 months | No |
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