- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03818269
Study of Subcutaneous Interstitial Pressure During Sepsis (PISEP)
The pathophysiology of sepsis is characterized by the sudden onset of vasodilation and vascular permeability with capillary leakage. This leakage contributes to the development of generalized edema which is not clinically detectable below 4 litres but which becomes visible after a few days. The edema accumulates mainly at the subcutaneous level due to the high compliance of this tissue. Edema, and therefore hydrosodium overload, testifies to the severity of the inflammation. However, it could also be harmful in itself (affecting microcirculation and increasing mortality) as suggested by numerous clinical and experimental studies.
The transfer of fluids between vascular and interstitial compartments during sepsis therefore has a central role in the pathophysiology of the disease and associated mortality. These transfers are mainly controlled at the microvascular level (with constant permeability) by the difference between capillary (CP) and interstitial (IP) pressures. In healthy subjects, subcutaneous IP is discreetly negative (-1 mmHg) and varies very little. On the other hand, a sometimes drastic decrease in IP has been described in various localized and systemic inflammatory situations. These pressure variations may be explained by the collagen structure of the interstitial tissue and a change in the three-dimensional conformation of these macromolecules induced by inflammation mediators. In an animal model of sepsis, a study showed significantly lower pressure in a group of animals in endotoxic shock. IP has never been measured in humans during sepsis. The objective of this study is to analyze subcutaneous IP (SCIP) in patients with septic shock compared with controls in order to evaluate the direct role of interstitial tissue in the onset of edema during sepsis.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Dijon, France, 21079
- CHU de Dijon
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Lyon, France, 69003
- HCL - Hôpital Edouard Herriot
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Criteria common to both groups:
- Adult,
- Admitted within the last 24 hours in intensive care,
- Under mechanical ventilation with orotracheal intubation,
- Without clinically detectable edema (in any area)
- Patient and/or guardian and/or close relative has given written consent
Patients included in the "septic shock" arm:
- Diagnosis of septic shock as defined by the "Sepsis-3" Consensus Conference (JAMA 2016) (34): documented or highly suspected infection with SOFA ≥ 2, persistent hypotension after correction of hypovolemia requiring vasopressor administration, and serum lactate > 2 mmol/l.
- Vascular filling < 50 ml/kg
Patients included in the control arm:
Absence of sepsis and shock from any cause:
- PAS > 100 mmHg
- Absence of vasopressors
- Preserved urine > 0.5 ml/kg/h
- Normal serum lactate
- Crystalloid infusions < 50ml/kg over the previous 12 hours
Exclusion Criteria:
- not affiliated to national health insurance
- under court protection
- pregnant or breastfeeding
- Clinical disseminated intravascular coagulation (DIC) with hemorrhagic syndrome
- Admitted after resuscitation for cardiac arrest
- Presenting cardiogenic shock
- Presenting acute pancreatitis
- Severe overall dehydration (clinical signs of dehydration and natremia > 150mmol/l)
- Presenting metformin intoxication
- In severe sepsis or septic shock for more than 24 hours,
- Dying or for whom death seems imminent (within 24 hours),
- Hypersensitivity to lidocaine and/or prilocaine or local anesthetics of the amide type or to any of the excipients of EMLAPATCH®
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Control
|
Subcutaneous interstitial measurement at D1 and D2
|
Other: Septic shock
|
Subcutaneous interstitial measurement at D1 and D2
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Value of Initial subcutaneous interstitial pressure
Time Frame: Day 0
|
Measure the difference between the subcutaneous interstitial pressure of patients in septic shock compared to patients without sepsis
|
Day 0
|
Collaborators and Investigators
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- DARGENT 2018
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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