The Effect of Dexmedetomidine on Microcirculation in Severe Sepsis

Severe Sepsis Clinical Trial

Official title:

The Effect of Dexmedetomidine on the Microcirculation in Patients With Severe Sepsis and Septic Shock

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02109965
• Other study ID #: 201311031MINB
• Status: Terminated
• Phase: Phase 4
• Start date: July 2014
• Est. completion date: February 24, 2018

Study information

• Verified date: February 2019
• Source: National Taiwan University Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Despite early goal-directed maintenance of normal macrocirculation, the reduction of 60-day mortality of patients with severe sepsis and septic shock remained unsatisfied (56.9% to 44.3%). One of the major causes of high mortality is microcirculatory dysfunction. Delayed diagnosis and treatment of microcirculatory dysfunction may cause tissue hypoperfusion and resulted in multiple organ dysfunction and death. Dexmedetomidine is a highly selective α2-adrenoreceptor agonist which exhibits sedative and analgesic effects. Recent studies suggest that dexmedetomidine also has anti-coagulation and anti-inflammatory effects, and it can reduce the mortality of endotoxemic rats and patients with severe sepsis. The investigators will conduct two animal studies and one clinical trial to investigate the effect of dexmedetomidine on microcirculatory dysfunction and organ injury in rat with endotoxemia and patients with severe sepsis and septic shock.

Sixty patients with severe sepsis and septic shock will be enrolled and randomized to control group or dexmedetomidine group. In the control group, the patients will be treated according to the clinical practice guideline. If sedation is required, non-dexmedetomidine sedative agents will be used. In the dexmedetomidine group, the patients will be treated according to the clinical practice guideline, and they will also receive continuous infusion of dexmedetomidine (infusion rate ranged from 0.1 to 0.7 mcg/kg/h) for 24 hours as needed. The sublingual microcirculation, serum level of Endocan, NGAL(Neutrophil Gelatinase-Associated Lipocalin), and BNP(B-type natriuretic peptide) will be examined at preset time points up to 24 hours. The vital signs, hemodynamic parameters, and survival of 28-day and 90-day will be recorded and analyzed.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 12
• Est. completion date: February 24, 2018
• Est. primary completion date: February 24, 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 20 Years and older

Eligibility

Inclusion Criteria:

• ICU patients who require sedation

• Patients who have diagnosis of severe sepsis / septic shock

• meet 2 or more of the 4 SIRS criteria

• with one organ dysfunction according the definition of Surviving Sepsis Campaign

Exclusion Criteria:

• less than 20 y/o

• refractory bradycardia (heart rate slower than 60 bpm despite of adequate treatment)

• 2nd and 3rd degree of AV-block

• the onset of severe sepsis/septic shock is more than 24h before enrollment

• APACHE II > 30 at enrollment

• Severe liver cirrhosis (Child B or C)

• New onset of myocardial infarction within 30 days or heart failure (NYHA 4)

• attend other trial in ICU within one month

• patient who is pregnant

• receive organ transplantation within one year

• expected survival is less than 30 days by attending physician

• receive cardiopulmonary resuscitation within 4 weeks

• patients who have signed consent of refusal of cardiopulmonary resuscitation and invasive therapy

• have allergic history to dexmedetomidine

• receive renal replacement therapy within 24 hours before enrollment

• patient with HIV infection

• non-native speaker

• other factors not eligible for enrollment concerned by attending physician

Related Conditions & MeSH terms

• Sepsis
• Severe Sepsis
• Toxemia

Intervention

Drug:
• Dexmedetomidine
Continue infusion (CIF) 0.1 - 0.7 mcg/kg/h Goal of sedation: Richmonad agitation-sedation scale 0 to -2
• Midazolam
CIF Goal of sedation: Richmonad agitation-sedation scale 0 to -2
• Propofol
CIF Goal of sedation: Richmonad agitation-sedation scale 0 to -2

Locations

Country	Name	City	State
Taiwan	National Taiwan University Hospital	Taipei

Sponsors (1)

Lead Sponsor	Collaborator
National Taiwan University Hospital

Country where clinical trial is conducted

Taiwan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Endocan level		24h
Other	Hemodynamic variables	Use EV1000 clinical platform MAP HR Cardiac index Stroke volume index Systemic vascular resistance index	6h and 24h
Other	NGAL level	Neutrophil Gelatinase-Associated Lipocalin	6h and 24h
Other	BNP level	B-type natriuretic peptide)	24h
Primary	Changes of total small vessel density and perfused small vessel density		6h
Secondary	Changes of total small vessel density and perfused small vessel density		24h
Secondary	Change of microvascular flow index		6h and 24h