- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05849779
Inhaled Sevoflurane for ARDS Prevention (IPA)
Randomized Clinical Trial of Inhaled Sedation With Sevoflurane in Critically Ill Patients at Risk of Developing the Acute Respiratory Distress Syndrome
This study focuses on patients who are at risk of developing a serious, life-threatening respiratory disease called Acute Respiratory Distress Syndrome (ARDS), which severely disrupts the function of their lungs.
Preclinical studies have shown that the use of a volatile anesthetic agent such as Sevoflurane could be beneficial in the treatment and prevention of this respiratory condition. By improving gas exchange and attenuating pulmonary inflammation in particular, this agent would make it possible to prevent deterioration or to restore pulmonary function more rapidly.
Half of the patients will receive inhaled sedation with sevoflurane and the other half will receive intravenous sedation already routinely used in participating ICUs (typically propofol, dexmedetomidine or a benzodiazepine, i.e. drugs approved for sedation).
The aim of this study is to assess whether the use of Sevoflurane could be beneficial in the prevention of ARDS.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
MAIN OBJECTIVE To assess the efficacy of inhaled sevoflurane, compared to current intravenous sedation practice, for improving PaO2/FiO2 in ICU patients at high risk for ARDS.
HYPOTHESIS The investigators hypothesized that a strategy of inhaled sedation with sevoflurane could be more effective than current intravenous sedation practice at improving pulmonary function during the early days of ICU admission, in patients at risk of ARDS.
Study Type
Enrollment (Estimated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Lise Laclautre
- Phone Number: +33473754963
- Email: llaclautre_perrier@chu-clermontferrand.fr
Study Locations
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Not Required For This Country
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Clermont-ferrand, Not Required For This Country, France, 63000
- Recruiting
- Chu Clermont-Ferrand
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Contact:
- Dominique Morand
- Phone Number: +33684894678
- Email: dmorand@chu-clermontferrand.fr
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18 years
- Admitted to participating ICUs with at least one known risk factor for ARDS and a LIPS equals to, or greater than, 4 (Appendix D)105
- Patient under invasive mechanical ventilation
- With expected duration of sedation superior or equal to 4 hours
- Affiliation to the French Sécurité Sociale
Exclusion Criteria:
- Patient under judicial protection, guardianship or supervision, as defined by art L1121-8 of the Public Health Code
- Patient under psychiatric care as defined by art. L1121-6 of the Public Health Code
- Patient deprived of their freedom by judiciary or administrative order
- Known pregnancy
- Presence of ARDS prior to randomization
- Endotracheal ventilation for greater than 24 hours prior to randomization
- Home mechanical ventilation (non-invasive ventilation or via tracheotomy) except for CPAP/BIPAP used solely for sleep-disordered breathing
- Tidal volume of 6 mL/kg predicted body weight (PBW) below 200 mL (i.e. height inferior to 134cm for a man and 139cm for a woman)
- Moribund patient, i.e. not expected to survive 24 hours despite intensive care
- Previous hypersensitivity or anaphylactic reaction to sevoflurane or to the intravenous sedation agent routinely used in the participating ICU (such as midazolam, propofol, or dexmedetomidine)
- Absolute contra-indications to the intravenous sedation agent routinely used in the participating ICU (such as midazolam, propofol, or dexmedetomidine)
- Medical history of malignant hyperthermia
- Long QT syndrome at risk of arrhythmic events
- Medical history of liver disease attributed to previous exposure to a halogenated agent (including sevoflurane)
- Suspected or proven intracranial hypertension
- Enrollment in another interventional trial with direct impact on oxygenation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Inhaled sedation with sevoflurane
Sevoflurane as vaporized via the Anesthesia Conserving Device (Sedaconda-ACD-S, Sedana Medical, Danderyd, Sweden).
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In both arms, the management of sedation will be conducted in the broader picture of ICU patient care, as per current standard practice in participating ICUs, and following the current guidelines for Pain, Agitation, Delirium, Immobility, and Sleep Disruption (PADIS) published in 2018 by the Society of Critical Care Medicine. Among many recommendations, this will include the monitoring and titration of both sedation and analgesia using validated scores such as the Richmond Agitation-Sedation Scale (RASS) for sedation. As a result of the current recommendations, the level, dose, and duration of sedation will vary among patients and will be decided by the treating clinicians. The choice of the analgesic drug(s) will be as per the treating clinicians. Other aspects of critical care will adhere to standard care, including the use of the "Checklist for Lung Injury Prevention" (CLIP).
Other Names:
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Active Comparator: Intravenous sedation
The investigators will not mandate the sedative type, but rather encourage the use of sedatives that are already routinely used in participating ICUs (typically a benzodiazepine, propofol, or dexmedetomidine, i.e. drugs approved for sedation).
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In both arms, the management of sedation will be conducted in the broader picture of ICU patient care, as per current standard practice in participating ICUs, and following the current guidelines for Pain, Agitation, Delirium, Immobility, and Sleep Disruption (PADIS) published in 2018 by the Society of Critical Care Medicine. Among many recommendations, this will include the monitoring and titration of both sedation and analgesia using validated scores such as the Richmond Agitation-Sedation Scale (RASS) for sedation. As a result of the current recommendations, the level, dose, and duration of sedation will vary among patients and will be decided by the treating clinicians. The choice of the analgesic drug(s) will be as per the treating clinicians. Other aspects of critical care will adhere to standard care, including the use of the "Checklist for Lung Injury Prevention" (CLIP).
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PaO2/FiO2 ratio
Time Frame: within 5 days from randomization
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longitudinal evolution in the PaO2/FiO2 ratio
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within 5 days from randomization
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Progression to ARDS
Time Frame: within 5 days from randomization
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Progression to ARDS will be assessed according to the Berlin criteria, including chest radiographs
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within 5 days from randomization
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Rate of pneumonia
Time Frame: Presence of pneumonia will be assessed daily until Day 5, and at Day 28 or ICU discharge, whichever comes first.
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Pneumonia will be defined according to the 3 following criteria:
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Presence of pneumonia will be assessed daily until Day 5, and at Day 28 or ICU discharge, whichever comes first.
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Ventilator-free days to day 28
Time Frame: 28 days after randomization
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Ventilator free days to day 28 are defined as the number of days from the time of initiating unassisted breathing to day 28 after randomization, assuming survival for at least two consecutive calendar days after initiating unassisted breathing and continued unassisted breathing to day 28.
If a patient returns to assisted breathing and subsequently achieves unassisted breathing to day 28, VFDs will be counted from the end of the last period of assisted breathing to day 28.
A period of assisted breathing lasting less than 24 hours and for the purpose of a surgical procedure will not count against the VFD calculation.
If a patient was receiving assisted breathing at day 27 or dies prior to day 28, VFDs will be zero.
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28 days after randomization
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Organ failure to day 5
Time Frame: 5 days after randomization
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Organ failure is defined as present when the most abnormal vital signs or clinically available lab value meets the definition of clinically significant organ failure according to SOFA scores.
Patients will be followed daily from randomization to day 5 for development of organ failures.
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5 days after randomization
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Mortality at day 28
Time Frame: 28 days after randomization
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The occurrence of death in the ICU will be recorded until day 28.
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28 days after randomization
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Length of ICU-stay up to 28 days
Time Frame: 28 days after randomization
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The total number of days from admission to ICU discharge will be recorded until day 28
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28 days after randomization
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Physiological measures: Oxygenation
Time Frame: 28 days after randomization
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- Oxygenation Index on study days 1-5
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28 days after randomization
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Physiological measures: PaCO2
Time Frame: 28 days after randomization
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- PaCO2 on study days 1-5
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28 days after randomization
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Physiological measures: pH
Time Frame: 28 days after randomization
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- Arterial pH on study days 1-5
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28 days after randomization
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Physiological measures: PEEP
Time Frame: 28 days after randomization
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- Level of PEEP (and static auto-PEEP in patients under controlled ventilation) on study days 1-5
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28 days after randomization
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Physiological measures: Plateau pressure
Time Frame: 28 days after randomization
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- Plateau pressure, static compliance of the respiratory system on study day 1-5
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28 days after randomization
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Physiological measures: Pneumothorax
Time Frame: 28 days after randomization
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- Development of pneumothorax through day 28
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28 days after randomization
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Physiological measures: Switch from controlled to pressure-support ventilation
Time Frame: 28 days after randomization
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- Time to switching from controlled to pressure-support ventilation through day 5
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28 days after randomization
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Physiological measures: Airway occlusion pressure
Time Frame: 28 days after randomization
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- Airway occlusion pressure at 0.1 s (P0.1), an index of respiratory drive, on the day the patient is switched to pressure-support ventilation if within 5 days since randomization
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28 days after randomization
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Hemodynamic measures
Time Frame: 28 days after randomization
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- Hemodynamic measures (mean arterial pressure, dose of infused norepinephrine or other vasopressor, serum lactate level) on study days 1-5
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28 days after randomization
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Physiological measures: Acute kidney injury
Time Frame: 28 days after randomization
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- KDIGO criteria for acute kidney injury 24 through day 5
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28 days after randomization
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Physiological measures: Supraventricular tachycardia
Time Frame: 28 days after randomization
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- Supraventricular tachycardia (SVT) or new onset atrial fibrillation through day 5
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28 days after randomization
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ICU-acquired delirium
Time Frame: 28 days after randomization
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The Confusion Assessment Method for the ICU (CAM-ICU, Appendix C )97 will be assessed daily from study entry to study day 28, death or ICU discharge, whichever comes first.
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28 days after randomization
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Biomarker measurements
Time Frame: from inclusion to 5 days
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Plasma samples will be collected from indwelling catheters (when available) at study entry and on days 1, 2, 3, 4, 5 in order to assemble a biological collection aimed at further investigating the effects of inhaled sedation with sevoflurane in patients with ARDS. The investigators will also collect whole blood samples at study entry and on day 2 for future studies of macrophage activation profiles and RNA and DNA studies. |
from inclusion to 5 days
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Collaborators and Investigators
Investigators
- Principal Investigator: Matthieu JABAUDON, University Hospital, Clermont-Ferrand
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Respiratory Tract Diseases
- Respiration Disorders
- Lung Diseases
- Disease
- Infant, Newborn, Diseases
- Lung Injury
- Infant, Premature, Diseases
- Syndrome
- Respiratory Distress Syndrome
- Respiratory Distress Syndrome, Newborn
- Acute Lung Injury
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Anesthetics, General
- Anesthetics
- Platelet Aggregation Inhibitors
- Anesthetics, Inhalation
- Sevoflurane
Other Study ID Numbers
- IPA trial (AOI 2019 JABAUDON)
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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