- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01617265
Study of a Strategy to Prevent Oversedation in Intensive Care Patients Under Mechanical Ventilation (AWARE)
Prevention of Oversedation in Intensive Care Patients Under Mechanical Ventilation : the AWARE Multicentric Randomized Trial
Study Overview
Status
Intervention / Treatment
Detailed Description
In intensive care unit (ICU) patients receiving mechanical ventilation (MV), potent hypnotics and morphinics are frequently administered to increase synchrony with the ventilator, control agitation and decrease discomfort and pain due to the tracheal tube, bed ridding, painful condition and diagnostic or therapeutic procedures.
However, administration sedatives or morphinics is often excessive and may result in deep and prolonged alteration of consciousness, delayed weaning from MV and prolonged MV. and exposes the patient to a higher risk of ventilator-associated pneumonia, ICU delirium and neuromuscular weakness at awakening.
The present randomized multicenter study will compare the day-90 mortality of a group of patients receiving conventional sedation to the mortality of a group of patients receiving sedation administered according to an algorithm aimed to prevent oversedation to the mortality. The algorithm is built on a graduate therapeutic response to increasingly intense symptoms of discomfort, pain, ventilator dyssynchrony and agitation, and includes the use of analgesics, non hypnotic benzodiazepines, neuroleptics, repeated intravenous (IV) boluses of hypnotics and short duration (6 hours) IV hypnotic infusions.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Agen, France, 47923
- Hôpital Saint-Esprit
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Angers, France, 49000
- CHU d'Angers
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Antony, France, 92166
- Hopital Prive d'Antony
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Argenteuil, France, 95100
- CH d'Argenteuil
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Beuvry, France, 62408
- Ch Germon Et Gauthier
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Bobigny, France, 93000
- Hôpital Avicenne
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Bordeaux, France, 33075
- Hopital St-Andre
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Boulogne Billancourt, France, 92100
- Hopital Ambroise Pare
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Brest, France, 29609
- CHRU de la Cavale Blanche
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Clamart, France, 92140
- Hopital Antoine Beclere
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Corbeil-Essones, France, 91106
- CH SUd Francilien
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Creteil, France, 94010
- CHU Henri Mondor
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Garches, France, 92380
- Hôpital Raymond Poincaré
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Le Chesnay, France, 78157
- CH de Versailles
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Le Kremelin-Bicetre, France, 94270
- CHU Kremlin-Bicêtre
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Lille, France, 59037
- Hôpital Roger Salengro
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Lyon, France, 69437
- Groupe Hospitalier Edouard Herriot
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Lyon, France, 69000
- CH St-Joseph St-Luc
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Marseille, France, 13385
- Hopital de la Timone
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Marseilles, France, 13015
- CHU Marseille Hopital Nord
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Meaux, France, 77104
- CH de Meaux
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Metz, France, 57038
- Hopital Notre-Dame de Bon Secours
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Monaco, France, 98012
- CH Princesse Grace
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Montfermeil, France, 93370
- GHIRM
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Nantes, France, 44035
- Hôpital Laënnec
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Nice, France, 06202
- Hôpital l'Archet
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Orléans, France, 45067
- CHR d'Orléans Hopital la Source
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Paris, France, 75014
- Institut Mutualiste Montsouris
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Paris, France, 75020
- Hôpital Tenon
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Paris, France, 75010
- Hopital St Louis
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Pau, France, 64046
- CH Francois Miterrand
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Poissy, France, 78300
- CH Poissy
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Pontoise, France, 95303
- CH de Pontoise
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Pringy, France, 74374
- CH de la Region d'Annecy
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Provins, France, 77488
- CH Leon Binet
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St-Brieuc, France, 22027
- CH de St-Brieuc
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St-Denis, France, 93200
- Hôpital Delafontaine
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St-Malo, France, 35403
- CH de St-Malo
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St-Mande, France, 94160
- HIA Béjin
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Tours, France, 37044
- CHRU Bretonneau
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Valenciennes, France, 59322
- Hopital Jean Bernard
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Villejuif, France, 94805
- Institut Gustave Roussy
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la Roche sur Yon, France, 85925
- CHD Les Oudairies
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18 and older
- Admission to ICU with expected mechanical ventilation duration > 48 hrs
- Mechanical ventilation in ICU for less than 12 hours
- Information provided to the patient or proxy
Exclusion Criteria:
- ICU Admission after cardiac arrest
- Acute or chronic neuromuscular disease
- Tracheotomy on ICU admission
- Acute cerebral injury with intracranial hypertension requiring continuous IV sedation with or without neuromuscular blockade
- Status epilepticus
- Treatment withdrawal decision
- Pregnancy, breast feeding
- Concurrent participation in another interventional study requiring a change in usual practice of sedation or mechanical ventilation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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EXPERIMENTAL: Prevention of oversedation group
In this arm sedation and analgesia will be administered according to a bundle of measures aimed at limiting oversedation, including repeated assessment of patients needs and graduate therapeutic response to control pain, discomfort, poor synchrony with the ventilator and agitation.
The therapeutic options include non hypnotic anxiolytics, repeated intravenous (IV) hypnotics boluses, short-duration (6 hours) IV hypnotics infusion and round the clock IV hypnotics infusion.
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Sedation and analgesia will be administered according to a bundle of measures aimed at limiting oversedation, including repeated assessment of patients needs and graduate therapeutic response to control pain, discomfort, poor synchrony with the ventilator and agitation.
The therapeutic options include non hypnotic anxiolytics, repeated IV hypnotics boluses, short-duration (6 hours) IV hypnotics infusion and round the clock IV hypnotics infusion.
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ACTIVE_COMPARATOR: Conventional sedation group
In this arm, sedation will be administered according to the usual practices in each participating center.
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Sedation and analgesia will be administered according to the usual practices in each participating center.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
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Day-90 mortality
Time Frame: Mortality at Day 90 after randomization
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Mortality at Day 90 after randomization
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Mortality at Day 28
Time Frame: at day 28
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at day 28
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Hospital mortality
Time Frame: at hospital discharge, up to day 90
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at hospital discharge, up to day 90
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1-yr mortality
Time Frame: at 1 yr
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at 1 yr
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Mechanical ventilation duration
Time Frame: From onset of mechanical ventilation to day 28
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From onset of mechanical ventilation to day 28
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Days alive with no mechanical ventilation
Time Frame: From ICU admission up to day 28
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From ICU admission up to day 28
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Occurence of ventilator-associated pneumonia
Time Frame: During mechanical ventilation duration, up to day 28
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During mechanical ventilation duration, up to day 28
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Use of non-invasive ventilation after extubation
Time Frame: From extubation to ICU discharge up to day 28
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From extubation to ICU discharge up to day 28
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Duration of ICU stay
Time Frame: From ICU admission to ICU discharge or death in ICU, up to day 90
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From ICU admission to ICU discharge or death in ICU, up to day 90
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ICU confusion
Time Frame: From Day 1 to 7, and at day 14, 21 and 28
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Number of patients alive, awaken, and free of ICU-delirium assessed on the CAM-ICU
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From Day 1 to 7, and at day 14, 21 and 28
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Proximal muscle weakness
Time Frame: from day 1 to 7, and at day 14, 21 and 28
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Number of patients alive, awaken, cooperative and free of proximal muscle weakness
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from day 1 to 7, and at day 14, 21 and 28
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Functional, cognitive and psychological status
Time Frame: At day 90 and 1 year
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Functional status (measured on the Barthel scale), depression (measured on the Hospital Anxiety & Depression Scale), Posttraumatic stress disorder (measured on the Impact of Event Scale), Quality of Life (measured on the SF-36) and patient living location
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At day 90 and 1 year
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Time to weaning onset
Time Frame: Time from mechancial ventilation initiation to first spontaneous breathing trial, up to day 28
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Time from mechancial ventilation initiation to first spontaneous breathing trial, up to day 28
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Number of patients requiring tracheotomy
Time Frame: During ICU stay, up to day 28
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During ICU stay, up to day 28
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First sitting in chair
Time Frame: During ICU stay, up to day 28
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During ICU stay, up to day 28
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Collaborators and Investigators
Collaborators
Investigators
- Study Chair: Bernard DE JONGHE, MD, French Society of Intensive Care
Publications and helpful links
General Publications
- Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004 Apr 14;291(14):1753-62. doi: 10.1001/jama.291.14.1753.
- Treggiari MM, Romand JA, Yanez ND, Deem SA, Goldberg J, Hudson L, Heidegger CP, Weiss NS. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009 Sep;37(9):2527-34. doi: 10.1097/CCM.0b013e3181a5689f.
- Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest. 1998 Aug;114(2):541-8. doi: 10.1378/chest.114.2.541.
- Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, Binhas M, Genty C, Rolland C, Bosson JL. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007 Apr;106(4):687-95; quiz 891-2. doi: 10.1097/01.anes.0000264747.09017.da.
- Constantin JM, Chanques G, De Jonghe B, Sanchez P, Mantz J, Payen JF, Sztark F, Richebe P, Lagneau F, Capdevila X, Bazin JE, Lefrant JY. [Current use of sedation and analgesia: 218 resuscitations in France services practices survey]. Ann Fr Anesth Reanim. 2010 May;29(5):339-46. doi: 10.1016/j.annfar.2010.01.014. Epub 2010 Apr 13. French.
- Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med. 1999 Dec;27(12):2609-15. doi: 10.1097/00003246-199912000-00001.
- De Jonghe B, Bastuji-Garin S, Fangio P, Lacherade JC, Jabot J, Appere-De-Vecchi C, Rocha N, Outin H. Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med. 2005 Jan;33(1):120-7. doi: 10.1097/01.ccm.0000150268.04228.68.
- Quenot JP, Ladoire S, Devoucoux F, Doise JM, Cailliod R, Cunin N, Aube H, Blettery B, Charles PE. Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med. 2007 Sep;35(9):2031-6. doi: 10.1097/01.ccm.0000282733.83089.4d.
- Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000 May 18;342(20):1471-7. doi: 10.1056/NEJM200005183422002.
- Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010 Feb 6;375(9713):475-80. doi: 10.1016/S0140-6736(09)62072-9. Epub 2010 Jan 29.
- SRLF Trial Group. Impact of oversedation prevention in ventilated critically ill patients: a randomized trial-the AWARE study. Ann Intensive Care. 2018 Sep 21;8(1):93. doi: 10.1186/s13613-018-0425-3.
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- SRLF-TG-1-AWARE
- 2011-004246-18 (EUDRACT_NUMBER)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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