Clinical Trials Logo

Clinical Trial Details — Status: Terminated

Administrative data

NCT number NCT00774631
Other study ID # P 060217
Secondary ID AOM 06 038
Status Terminated
Phase Phase 4
First received October 16, 2008
Last updated September 14, 2012
Start date March 2009
Est. completion date July 2012

Study information

Verified date July 2012
Source Assistance Publique - Hôpitaux de Paris
Contact n/a
Is FDA regulated No
Health authority France: Ministry of HealthFrance: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)
Study type Interventional

Clinical Trial Summary

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.


Description:

Investigational procedure:

This study evaluates the impact of mild induced hypothermia (32-34°C) during 48 hours followed by passive rewarming according to recommendations described in appendix. All treatment will be according to local recommendations and guidelines of medical societies and literature. Physicians are advised to use these recommendations; however, the best treatment option for the individual patient should be used.

Mild Induced hypothermia:

Investigators are advised to use the cooling techniques as used in patients with cardiac arrest. Thus, the choice of cooling method will be left to investigators. Hypothermia will be induced by cold saline infusion as described in appendix 5 [6, 48]. Core temperature will be monitored by oesophageal probe and maintained between 32°C and 34°C during 48 hours and followed by strictly passive rewarming. During this phase of treatment, patients will receive deep sedation associated with neuromuscular blockers. Centers participating to the trial will have expertise in cooling methods.

Controls:

Controls will receive standard care and will be also be deeply sedated for 48 hours.


Recruitment information / eligibility

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.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment


Intervention

Procedure:
Mild induced hypothermia (32-34°C)
Mild Induced hypothermia: Investigators are advised to use the cooling techniques as used in patients with cardiac arrest. Thus, the choice of cooling method will be left to investigators. Hypothermia will be induced by cold saline infusion as described in appendix 5 [6, 48]. Core temperature will be monitored by oesophageal probe and maintained between 32°C and 34°C during 48 hours and followed by strictly passive rewarming. During this phase of treatment, patients will receive deep sedation associated with neuromuscular blockers. Centers participating to the trial will have expertise in cooling methods.
local recommendations and guidelines
Investigational procedure: This study evaluates the impact of mild induced hypothermia (32-34°C) during 48 hours followed by passive rewarming according to recommendations described in appendix. All treatment will be according to local recommendations and guidelines of medical societies and literature. Physicians are advised to use these recommendations; however, the best treatment option for the individual patient should be used. Controls will receive standard care and will be also be deeply sedated for 48 hours.

Locations

Country Name City State
France Hopital Bichat Claude Bernard Paris

Sponsors (1)

Lead Sponsor Collaborator
Assistance Publique - Hôpitaux de Paris

Country where clinical trial is conducted

France, 

Outcome

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
See also
  Status Clinical Trial Phase
Completed NCT01589289 - Rapid Diagnostic Tests and Clinical/Laboratory Predictors of Tropical Diseases in Neurological Disorders in DRC Phase 3
Completed NCT02274285 - DTaP-IPV/Hib Vaccine Primary & Booster Vaccinations Versus Co-administration of DTaP-IPV and Hib Vaccine in Japanese Infants Phase 3
Recruiting NCT04771884 - Population Pharmacokinetics of Commonly Used Antimicrobial Agents in Children of Bacterial Meningitis With Augmented Renal Clearance
Completed NCT01431326 - Pharmacokinetics of Understudied Drugs Administered to Children Per Standard of Care
Not yet recruiting NCT02467309 - Vitamin d Levels in Children With Bacterial Meningitis N/A
Completed NCT01547715 - Immunogenicity and Safety of Meningococcal ACWY Conjugate Vaccine in Healthy Subjects From 2 to 75 Years of Age in India Phase 3
Completed NCT00619203 - Oral Glycerol and High-Dose Rectal Paracetamol to Improve the Prognosis of Childhood Bacterial Meningitis Phase 3
Recruiting NCT05146570 - Early Diagnosis of Native and Device-associated Meningitis N/A
Completed NCT03595761 - Meningitis With Cerebral Vasculitis in Children
Recruiting NCT03418441 - Central Nervous System Infections in Denmark
Completed NCT01540838 - Slow Initial β-lactam Infusion With High-dose Paracetamol to Improve the Outcomes of Childhood Bacterial Meningitis Phase 4
Recruiting NCT03499652 - Neonatal Bacterial Meningitis Cohort
Completed NCT01410474 - Immunogenicity and Safety of Meningococcal ACWY Conjugate Vaccine in Healthy Subjects From 2 to 18 Years in Taiwan Phase 3
Completed NCT03226379 - Driving Reduced AIDS-associated Meningo-encephalitis Mortality N/A
Completed NCT03891758 - Confirmatory Study of BK1310 in Healthy Infants Phase 3