Insufficient Oxygenation in Septic Patients

Sepsis Clinical Trial

— INOX-SEPSIS  

Official title:

Insufficient Oxygenation in Septic Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03842722
• Other study ID #: NL64824.058.18
• Status: Completed
• Start date: February 13, 2019
• Est. completion date: September 28, 2023

Study information

• Verified date: May 2024
• Source: Sanquin-LUMC J.J van Rood Center for Clinical Transfusion Research
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This study will describe the change of mitochondrial oxygen tension (mitoPO2) compared to traditional parameters of oxygenation and oxygen balance in the first 24 hours of septic patients admitted to the intensive care unit of an academic hospital. The mitoPO2 will be measured on prespecified measurement moments in the ICU. With each measurement moment, arterial and central venous blood gasses will be taken too.

Description:

Evidence is increasing that there is no clear parameter for tissue oxygenation in critically ill septic patients to guide resuscitation. New studies have shown the potential of protoporphyrin IX-triple state lifetime technique to measure mitochondrial oxygenation tension (mitoPO2) in vivo, which possibly is an early indicator of oxygen disbalance in the cell and therefore a physiological trigger for fluid therapy.

Objectives: 1. To describe mitoPO2 measurements in patients with sepsis who are about to receive fluid therapy 2. To describe the effects of fluid therapy and the associated change in mitoPO2 and change in other physiologic measures of tissue oxygenation and oxygen balance 3.To describe the association between mitoPO2 and vital organ (dis)functions and change of SOFA (Sequential organ failure assessment) score after 24hrs 5. To describe the microcirculatory, cellular and mitochondrial function during the first 24 hours of septic patients.

Study population: critically ill patients with sepsis which are admitted to the intensive care unit through the emergency department or hospital ward and in whom fluid therapy (crystalloid, albumin and red cell transfusion) is planned.

Main study endpoints

Primary endpoint: Change in mitoPO2 after fluid therapy. This will be compared to traditional parameters used to measure oxygenation and oxygen balance

Secondary endpoints:

• Association of mitoPO2 trend with separate (ischemic) organ (dis)function. The SOFA score after 24 hours will also be assessed.

• Safety of mitoPO2 measurements in critically ill septic patients.

• Description of the association of sepsis with microcirculatory function, cellular function and mitochondrial function.

• Description of the association between mitoPO2 change and clinical outcomes , like length of stay(both ICU and in-hospital) and mortality (both ICU and in-hospital).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 81
• Est. completion date: September 28, 2023
• Est. primary completion date: September 28, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Age of patient is at least 18 years

• Patients diagnosed with sepsis in the emergency department or hospital ward

• Patients are admitted to the ICU via the hospital ward or emergency department

• Informed consent is given either by the patient or if the patient is too ill to give informed consent, by his or her legal representative.

• Patients have an arterial catheter in situ, since blood samples will be taken for the study. Most patients admitted to the ICU have an arterial catheter in place since it is part of standard care.

Exclusion Criteria:

• Patients younger than 18 years

• Patients with sepsis discharged after emergency department visit

• Patients admitted to a hospital ward other than the ICU after emergency department visit

• Patients who cannot give informed consent themselves and without a legal representative will be excluded since no informed consent can be obtained

• Patients known with porphyria and/or photodermatosis will be excluded, since the risk of phototoxicity

• Patients with hypersensitivity to the active substance or to the plaster material of ALA (5-aminolevulinic acid)

• Pregnant or breast feeding women since there is no adequate data form the use of ALA in pregnant or breast feeding women

• Insufficient comprehensibility of the Dutch language

Related Conditions & MeSH terms

• Critical Care
• Fluid Therapy
• Mitochondria
• Oxygen
• Sepsis

Intervention

Device:
• Protoporphyrin IX - Triplet State Lifetime Technique
Protoporphyrin IX - Triplet State Lifetime Technique is a way to measure mitochondrial oxygen tension in a non-invasive way at bedside.

Locations

Country	Name	City	State
Netherlands	Leiden University Medical Center	Leiden

Sponsors (2)

Lead Sponsor	Collaborator
Sanquin-LUMC J.J van Rood Center for Clinical Transfusion Research	Leiden University Medical Center

Country where clinical trial is conducted

Netherlands, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change of mitoPO2 during first 24 hours of a septic patient	The primary endpoint is the change of mitoPO2(mitochondrial oxygenation) before and after fluid therapy in patients with sepsis. This will be compared to traditional parameters used to measure tissue oxygenation and oxygen balance (central venous oxygen saturation, mean arterial pressure and lactate).	24 hours
Secondary	SOFA (sequential organ failure assessment) score after 24 hours	The association of mitoPO2 change in 24 hours with the Sequential Organ Failure Assessment score after 24 hours will be assessed. With the help of this information, more insight can be given in how much information the cutaneous mitoPO2 measurement gives about the organs separately and together.	24 hours
Secondary	Organ (dis)function	To describe the association between mitoPO2 change and separate organ functions.	24 hours
Secondary	Validation of mitoPO2 measurement with blood based biomarkers of cellular function	Cellular function will be assessed with blood-based biomarkers mitochondrial membrane potential (MMP), presence of cellular reactive oxygen species (ROS) molecules and glutathione (GSH) activity. Mitochondrial function will be assessed with mitoPO2 measurements.	24 hours
Secondary	Safety (incidence of adverse and serious adverse events)	The adverse and serious adverse events of the mitoPO2 measurements will be assessed.	24 hours
Secondary	Length of ICU stay	Association of mitoPO2 change and length of intensive care unit-stay.	3 months
Secondary	Length of hospital stay	Association of mitoPO2 change and length of hospital stay.	3 months
Secondary	ICU mortality	Association of mitoPO2 change and intensive care unit mortality.	3 months
Secondary	In-hospital mortality	Association of mitoPO2 change and in-hospital mortality.	3 months