Sepsis Clinical Trial
Official title:
Effect of Dexmedetomidine on Mortality, Duration of Mechanical Ventilation and Multi-organ Function in Sepsis Patients Under Lighter Sedation by Randomized Control Trial
Background:
Dexmedetomidine, a highly selective arfa2-adrenergic agonist, is known to be a unique
sedative agent which causes less acute tolerance, drug addiction and withdrawal compared
with gamma-aminobutyrate (GABA) agonists. Dexmedetomidine was approved for short-term ICU
sedation in 2004 in Japan, and it has been used particularly for surgical ICU patients. In
August 2010 dexmedetomidine was approved in Japan for sedation lasting more than 24 hours.
Recent evidence demonstrated that dexmedetomidine has organ protective effects including
neuroprotection, cardioprotection, renal protection, gastrointestinal tract action, and
anti-inflammatory action. Dexmedetomidine was shown to significantly decrease the infarct
size in isolated rat hearts. Additionally, dexmedetomidine exhibited a preconditioning
effect against ischemic injury in hippocampal slices, and this result was considered an
apoptosis suppression effect of dexmedetomidine. Aydin C et al reported that dexmedetomidine
enhanced the spontaneous contractions of the ileum in peritonitis rats compared with
propofol and midazolam. Taniguchi and colleagues demonstrated that dexmedetomidine reduced
high mortality rates and the plasma cytokine concentrations, interleukin-6 and tumor
necrosis factor alpha in endotoxemic rats.
A meta-analysis has shown that perioperative alfa2-adrenergic agonists, including
dexmedetomidine infusion, decreased cardiovascular events on patients undergoing cardiac
surgery. Dexmedetomidine treated patients undergoing thoracotomy indicated increase in urine
output, reduction in serum creatinine, and the suppression of diuretics in a randomized
placebo-controlled double-blind study. Septic patients receiving dexmedetomidine had
improved 28-day mortality rates compared with septic patients receiving lorazepam in a
sub-group analysis of MENDS randomized controlled trial.
These positive effects of dexmedetomidine on the cardiovascular system, neurons, kidneys,
gastrointestinal tract action, and an anti-inflammatory action, are expected to improve
mortality in septic patients. However, large clinical research studies have not been
conducted yet. We designed and conducted the DESIRE trial (DExmedetomidine for Sepsis in ICU
Randomized Evaluation trial) to test a hypothesis that dexmedetomidine may improve clinical
outcome and has these organ protective effects on septic patients.
Objective:
To determine whether dexmedetomidine improves clinical outcome and has organ protective
effects on septic patients.
n/a
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