- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02150512
Resuscitation Strategies in Septic Shock (ReSSeS)
Resuscitation Strategies in Septic Shock. A Randomized Controlled Trial of Two Different Fluid Loading Strategies in ICU Patients With Early Septic Shock
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Rationale: Fluid loading is an important intervention in patients with severe sepsis and septic shock in order to prevent development of multi organ failure and mortality. The Surviving Sepsis Guidelines recommend during the first 6 hours of resuscitation a central venous pressure (CVP) based fluid loading approach, targeting to 12-15 mmHg in mechanically ventilated patients. CVP however has proven to be a poor indicator for preload and preload dependency, while dynamic parameters as stroke volume variation (SVV) derived from the transpulmonary thermodilution technique (TPTD) are superior. Together with the ability to measure the extravascular lung water (EVLW), the TPTD technique may guide fluid management more accurately and may prevent deleterious fluid overloading.
Objective: The risk of fluid overloading in mechanically ventilated patients with septic shock is less when fluid administration is based on a fluid loading protocol using SVV together with EVLW measurements than applying the Surviving Sepsis Guidelines targeting CVP to 12-15 mmHg, in at least the first 6 hours of resuscitation, translating in more ventilator free days (VFDs) Study design: This is a prospective, randomized, non-blinded, single-center, controlled clinical trial comparing two different fluid resuscitation strategies in patients with septic shock. Patients will be randomized for fluid management based on the Surviving Sepsis Guidelines (SSG) or based transpulmonary thermodilution (TPTD) derived SVV and EVLW in at least the first 6 hours of resuscitation.
Study population: All patients of ≥18 years admitted to the ICU because of septic shock together with the need for mechanical ventilation are eligible for randomization Intervention: During at least the first 6 hours of resuscitation, the standard group (SSG guided therapy) follows a fluid resuscitation protocol based on the Surviving Sepsis Campaign recommendations. Initial trigger for fluid loading when circulatory insufficiency is present will be the CVP (target ≥12 mmHg). The intervention group (TPTD guided therapy) follows a fluid resuscitation protocol based on SVV and EVLW. Initial trigger for fluid loading when circulatory insufficiency is present will be SVV. The study protocol will be applied up to a maximum of 72 hours.
Main study parameters/endpoints: VFDs on day 28. Benefit and risks associated with participation: Since inclusion criteria include a TPTD (5F fiber optic, femoral artery) catheter, the inconvenience as compared to standard treatment is minimal. Current routine hospital policy involves TPTD catheter insertion in most of the patients meeting the inclusion criteria specified above.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: RJ Trof, MD PhD
- Phone Number: 0031-53-4872000
- Email: r.trof@mst.nl
Study Contact Backup
- Name: M Burgmeijer
- Phone Number: 0053-4872000
- Email: researchIC@mst.nl
Study Locations
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Enschede, Netherlands
- Recruiting
- Medisch Spectrum Twente
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Contact:
- RJ Trof, MD PhD
- Email: r.trof@mst.nl
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Contact:
- Research IC
- Email: researchIC@mst.nl
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Principal Investigator:
- RJ Trof, MD PhD
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Sub-Investigator:
- A Beishuizen, MD PhD
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Sub-Investigator:
- JW Vermeijden, MD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age > 18 years
- Clinical evidence of sepsis (microbiology confirmation, radiological or direct view (pus in biological fluid) or direct surgical view).
≥ 2 SIRS criteria:
- Temperature < 36.0°C or > 38.0°C
- Heart rate > 90 bpm
- Respiratory rate > 20 rpm or PaCO2 < 4.2 kPa or need of mechanical ventilation.
- Leukocytes > 12.0 x109/L or < 4.0 x109/L or >10% bands
- Circulatory shock defined as sustained systemic hypotension (systolic arterial pressure <90 mmHg or MAP <65 mmHg (<75 mmHg in a hypertensive patient) despite a 1,000 ml IV fluid challenge over 30 min (including IV fluids administered pre-ICU) or the need for vasopressor therapy. Hypertensive patients are patients with a history of confirmed hypertension treated with antihypertensive agents.
- Mechanical ventilation by endotracheal tube (any form)
Exclusion Criteria:
- Pregnancy
- Pre-terminal illness with life expectancy <28 days
- Duration of circulatory shock >6 hours
- Severe peripheral arterial vascular occlusion disease (Fontaine level III-IV)
- Inability for femoral artery canulation
- No informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Transpulmonary thermodilution (TPTD)
The intervention group (TPTD guided therapy) follows a fluid resuscitation protocol based on stroke volume variation (SVV) and extravascular lung water (EVLW).
Initial trigger for fluid loading when circulatory insufficiency is present will be SVV.
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Initial trigger for fluid loading when circulatory insufficiency is present will be SVV.
If SVV ≤10% in patients on controlled mechanical ventilation with tidal volumes of ≥8 ml/kg, fluid loading will not be performed.
If SVV >10% or spontaneous breathing efforts are present, a fluid challenge should be performed.
Also if patients are on controlled mechanical ventilation with tidal volumes of ≤7 ml/kg, a fluid challenge should be performed.
If fluid responsiveness is present and SVV decreases to ≤10%, further fluid loading should be stopped.
If SVV is still >10%, the increase in EVLW will decide whether to continue fluid loading or not; if EVLW is ≥12 mL/kg PBW and EVLW increases upon fluid loading, further fluid loading should be stopped.
Other Names:
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Active Comparator: Surviving Sepsis Guidelines (SSG)
The standard group (SSG guided therapy) follows a fluid resuscitation protocol based on the Surviving Sepsis Campaign recommendations.
Initial trigger for fluid loading when circulatory insufficiency is present will be the CVP (target ≥12 mmHg).
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Initial trigger for fluid loading when circulatory insufficiency is present will be the CVP (target ≥12 mmHg).
If circulatory insufficiency is absent, fluid loading will not be initiated or stopped independently of the actual CVP level.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
ventilator free days (VFDs)
Time Frame: 28 days
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VFDs from enrolment to extubation until day 28
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28 days
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
duration of circulatory shock (hours)
Time Frame: 72 hours
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Duration of circulatory shock, defined as the amount of consecutive hours on vasopressor therapy
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72 hours
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
mortality
Time Frame: 30 days and 90 days
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ICU mortality plus 30-days and 90-days mortality
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30 days and 90 days
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RIFLE-F score
Time Frame: 5 days
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Evolution of renal function (RIFLE-F score) during the first 5 days after inclusion and use of renal replacement therapy (RRT)
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5 days
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fluid balance
Time Frame: 5 days
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Fluid balances during the first 5 days after inclusion
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5 days
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length of stay in the ICU
Time Frame: 28 days
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Length of stay in the ICU
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28 days
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: RJ Trof, MD PhD, Medisch Spectrum Twente, Department of Intensive Care
- Study Director: A Beishuizen, MD PhD, Medisch Spectrum Twente, Department of Intensive Care
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- ReSSeS-2014
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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