- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03477344
Dexmedetomidine After Cardiac Surgery for Prevention of Delirium (EXACTUM)
Dexmedetomidine After Cardiac Surgery for Prevention of Delirium: The Exactum Study a Randomised Double Blind Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Delirium occurs in about 25% of patients after cardiac surgery. It is an independent factor of poor outcome and recovery after ICU stay as it is associated with mortality and impaired mental function one year after its onset. It is associated with increased public health costs during the hospital stay and after.
The use of Dexmedetomidine as sedative medication is more and more described. It is well established that it can lower delirium onset comparatively to Midazolam or Propofol. It is also useful in agitated delirium as a complementary medication to reduce delirium duration. A study published by Su et al in 2016 assessed the efficacy of Dexmedetomidine in prevention of post-surgical delirium for patients older than 65 years after non cardiac surgery. Patients were mainly admitted in the ICU after abdominal surgery for malignant tumor. Dexmedetomidine was used at very low dose to promote sleep during ICU stay. In this study the onset of delirium was significantly lowered by one half for the first week after surgery. However, this study only focused on older patients and non-cardiac surgery population with short mechanical ventilation duration, short ICU stay and low incidence of complications.
We designed a prospective, double blind, randomized, controlled versus placebo study to evaluate the efficacy of nightly low dose of Dexmedetomidine infusion to promote sleep and lower delirium in a population of post cardiac surgery patients. This population is characterized by longer ICU stay, more physical restraints such as catheters and drains, pain and sleep deprivation. It is associated with higher prevalence of Delirium and agitation leading to exposure to severe agitation related adverse events. In the study by Su and al low dose Dexmedetomidine did not induce adverse events such as bradycardia or hypotension, conversely safety outcomes showed that Dexmedetomidine use was associated with fewer tachycardia and hypoxaemia. Moreover, data shows that Dexmedetomidine is likely to play a cardio protective role in the same way as Clonidine. Those findings are encouraging for its use after cardiac surgery.
Delirium will be assessed by the Confusion Assessment Method for the ICU (CAM ICU) and the primary endpoint of the study is the occurrence of delirium in the first 7 days following surgery.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
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-
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Angers, France
- Angers University Hospital
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Brest, France, 29609
- CHRU de Brest
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Clermont-Ferrand, France
- Clermont Ferrand university hospital
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Grenoble, France, 38000
- CHU de Grenoble
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Massy, France
- Hôpital Privé Jacques Cartier
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Nantes, France, 5600
- CHU de Nantes
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Paris, France, 75000
- CHU La Pitié Salpêtrière
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Poitiers, France, 86000
- CHU Poitiers
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Rennes, France, 22000
- CHU de Rennes
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- patients aged 65 or more who undergo cardiac surgery on and off-pump: coronary artery bypass graft, cardiac valve replacement or both.
- Consent signed
Exclusion Criteria:
- history of mental illness, dementia
- inclusion in another study evaluating sedation or pain
- length of stay in ICU less than 24 hours
- alpha 2 agonists allergy
- surgery performed in an immediate emergency situation
- uncontrolled hypotension
- second and third degree atrioventricular block without pacemaker
- severe hepatic insufficiency
- acute cerebrovascular diseases
- patient treated with clonidine
- patient with disturbed preoperative liver assessment (hepatocellular insufficiency)
- patient under guardianship or curatorship
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Dexmédétomidine
Intravenous infusion with electric syringe of Dexmedetomidine 0,4ug/ml.
Rate 0,1ug/kg/h to 1,4ug/kg/h.
Nightly infusion from 20:00 to 08:00.
The drug is titrated to achieve RASS between -1 and 1. Modification of infusion rate by 0,1ug/kg/h is recommended with stabilization phase of 1 hour before another rate adjustment.
|
Intravenous infusion with electric syringe of Dexmedetomidine 0,4ug/ml.
Rate 0,1ug/kg/h to 1,4ug/kg/h.
Nightly infusion from 20:00 to 08:00.
The drug is titrated to achieve RASS between -1 and 1. Modification of infusion rate by 0,1ug/kg/h is recommended with stabilization phase of 1 hour before another rate adjustment.
|
PLACEBO_COMPARATOR: Sodium Chloride 0,9%
Intravenous infusion with electric syringe of normal saline.
Rate modifications follow the same rules as in experimental group.
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Intravenous infusion with electric syringe of normal saline.
Rate modifications follow the same rules as in experimental group.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Delirium
Time Frame: 7 days
|
Occurrence of delirium diagnosed by the Confusion Assessment Method (CAM ICU) at any time in the first seven days after surgery
|
7 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
agitation with be assessed using the Richmond agitation and sedation score
Time Frame: 7 days
|
Score Term Description
|
7 days
|
length of ICU stay
Time Frame: 28 days
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Lenght of patient's ICU stay
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28 days
|
length of hospital stay
Time Frame: 28 days
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Length of Patient's hospital stay
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28 days
|
quality of life 3 months after surgery with the The Short Form (36) Health Survey score
Time Frame: 90 days
|
The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health.
The SF-36 is a measure of health status and an abbreviated variant of it, the SF-6D, is commonly used in health economics as a variable in the quality-adjusted life year calculation to determine the cost-effectiveness of a health treatment.
The original SF-36 came out from the Medical Outcome Study, MOS, done by the RAND Corporation.
Since then a group of researchers from the original study released a commercial version of SF-36 while the original SF-36 is available in public domain license free from RAND.
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90 days
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cognitive capacity 3 months after surgery evaluated with the Cognitive Failures Questionnnaire (CFQ)
Time Frame: 90 days
|
The Cognitive Failures Questionnaire is a self-report scale that taps failures in everyday actions, perception and attention, and memory over the last month.
It consists of 25 items that are scored on a 5-point scale (0=never; 4=very often).
Illustrative items are 'Do you fail to notice signposts on the road?' and 'Do you forget where you put something like a newspaper or a book?' Scores are summed to obtain a total CFQ score varying from 0 to 100, with higher scores indicating more self-reported cognitive failures.
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90 days
|
agitation related adverse events onset and number
Time Frame: 7 days
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-self-extubation
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7 days
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agitation related adverse events onset and number
Time Frame: 7 days
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-catheter or medical devices removal (drains, urinary catheter, arterial and central venous catheters, externenal pacemaker)
|
7 days
|
agitation related adverse events onset and number
Time Frame: 7 days
|
-fall of bed
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7 days
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agitation related adverse events onset and number
Time Frame: 7 days
|
-getaway
|
7 days
|
agitation related adverse events onset and number
Time Frame: 7 days
|
-contention removal
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7 days
|
agitation related adverse events onset and number
Time Frame: 7 days
|
-aggressive acts
|
7 days
|
Self-assessment of sleep quality
Time Frame: 7 days
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Assessment by a numerical scale from 0 to 10 and the Leeds Sleep questionnaire
|
7 days
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Intra hospital mortality and Mortality at 3 months of surgery
Time Frame: 3 months
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3 months
|
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Cognitive capacity
Time Frame: 3 months
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Cognitive capacity assessed by Cognitive Failures Questionnaire (CFQ) at 3 months of surgery
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3 months
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Post-traumatic stress disorder
Time Frame: 3 months
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Post-traumatic stress disorder assessed by the PCL-5 questionnaire at 3 months of surgery
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3 months
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Collaborators and Investigators
Sponsor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Nervous System Diseases
- Neurologic Manifestations
- Confusion
- Neurobehavioral Manifestations
- Neurocognitive Disorders
- Delirium
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Hypnotics and Sedatives
- Dexmedetomidine
Other Study ID Numbers
- 29BRC18.0051 (EXACTUM)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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