Daily Sedative Interruption in Critically Ill Patients Being Managed With a Sedation Protocol

Critical Illness Clinical Trial

Official title:

A Randomized Trial of Daily Sedative Interruption in Critically Ill Patients Being Managed With a Sedation Protocol - A Pilot Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00298493
• Other study ID #: MSH REB#00-0032-A
• Status: Completed
• Phase: Phase 2
• First received: February 28, 2006
• Last updated: February 28, 2006
• Start date: February 2001
• Est. completion date: September 2004

Study information

• Verified date: February 2006
• Source: Mount Sinai Hospital, Canada
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Health Canada
• Study type: Interventional

Clinical Trial Summary

All critically ill, mechanically ventilated patients in the Intensive Care Unit receive medications to relieve pain and anxiety. However, accumulation of these medications can be associated with serious complications, most notably longer time on the breathing machine and in the ICU. Two strategies have been shown to dramatically improve patient outcomes: nurse-directed protocols for giving sedation, and daily interruption of sedation. However, these strategies have not been widely adopted, because of physicians' concerns, and because it is unclear which strategy is better. Given that patient outcome is improved with either of these strategies, the fundamental question that arises is whether patients managed with a combination of two strategies which both reduce drug accumulation (protocolized sedation and daily interruption) have an even better outcome than patients managed with only one of them (protocolized sedation). We propose a multicenter study in which 700 critically ill, mechanically ventilated patients will have their sedation managed with protocolized sedation alone, or both strategies. Both groups of patients will have the following recorded: ICU and hospital lengths of stay, mortality, total sedative drug use, ICU human resources used, side effects and recall of their ICU stay. The results of this large multi-center trial will help to inform best practice with regard to sedation management of critically ill patients in Canada and elsewhere. In addition, reducing ICU stay could be economically attractive, as the cost of an ICU day in Canada is approximately $3000.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 65
• Est. completion date: September 2004
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. age>18 years

2. Mechanically ventilated, with anticipated need for MV = 48 hours

3. ICU team has decided to initiate continuous sedative/analgesic infusion(s)

4. informed consent.

Exclusion Criteria:

1. Admission after resuscitation from cardiac arrest

2. Traumatic brain injury

3. Currently receiving neuromuscular blocking agents

4. Allergy to any of the study medications

5. History of alcohol, sedative or analgesic abuse

6. History of psychiatric illness

7. Acute or chronic neurologic dysfunction

8. Administration of sedatives for >24 hr,

9. Lack of commitment to aggressive treatment

10. Current enrollment in a related trial

11. Previous enrollment in this trial.

Study Design

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

Related Conditions & MeSH terms

• Critical Illness
• Mechanical Ventilation

Intervention

Procedure:
• Sedation management strategy

Locations

Country	Name	City	State
Canada	Mount Sinai Hospital	Toronto	Ontario

Sponsors (2)

Lead Sponsor	Collaborator
Mount Sinai Hospital, Canada	The Physicians' Services Incorporated Foundation

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Duration of Mechanical Ventilation
Primary	ICU and Hospital Lengths of stay
Secondary	Adverse events
Secondary	Patient Recall
Secondary	Caregiver workload