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Koffein, postoperativt delirium og ændring i resultater efter kirurgi (CAPACHINOS-2) undersøgelse

5. november 2026 opdateret af: Phillip Vlisides, University of Michigan

The objective of this study is to test the effects of caffeine on neurocognitive and clinical recovery after major surgery. Specifically, this trial tests the primary hypothesis that caffeine will reduce the incidence of postoperative delirium.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Delirium is a syndrome characterized by failure of basic cognitive functions that affects approximately 20-50% of older surgical patients. Delirium during surgical recovery is associated with increased mortality, cognitive and functional decline, and prolonged hospitalization. In fact, 3-year survival rates for acutely hospitalized patients with delirium, and subsyndromal delirium, are both less than 50%. Older age is predictive of delirium after surgery, and with aging surgical populations, the incidence of postoperative delirium and related complications are likely to increase in the coming years.

Caffeine represents a novel, neurobiologically informed candidate intervention for reducing risk of early postoperative delirium. Caffeine promotes arousal via adenosine receptor antagonism and improves cognitive function concurrent with increased cortical cholinergic tone. Our preliminary data suggest that caffeine reduces risk of postanesthesia care unit (PACU) delirium in adult non-cardiac surgery patients by optimizing cortical dynamics for cognition. Caffeine also optimizes key neurocognitive processes that support information processing and may improve other, related aspects of clinical recovery, such as rebound headache in habitual caffeine users. The objective of this trial is to thus test the effects of caffeine on neurocognitive and clinical recovery after major surgery. Specifically, the primary hypothesis is that caffeine will reduce the incidence of postoperative delirium. The secondary objectives are to (1) test whether caffeine positively impacts the quality of postoperative recovery via validated patient-reported measures and (2) identify neural correlates of delirium and Mild Cognitive Impairment via advanced electroencephalographic (EEG) analysis.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

250

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

    • Michigan
      • Ann Arbor, Michigan, Forenede Stater, 48109
        • Michigan Medicine

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

70 år og ældre (Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. Adult (>/= 70 years old) undergoing non-cardiac, non-intracranial neurologic, non-major vascular surgery requiring general anesthesia with a planned admission for at least 48 hours.
  2. Stated willingness to comply with all study procedures and availability for the duration of the study.
  3. Provision of signed and dated informed consent form.

Exclusion Criteria:

  1. Emergency surgery
  2. Outpatient surgery
  3. Severe cognitive impairment precluding the capacity for informed consent
  4. Seizure disorder history
  5. Intolerance or allergy to caffeine (based on subjective reporting or objective documentation)
  6. Weight >130 kg (as a 3 mg/kg dose would approach the upper limit of daily intake recommended by the FDA)
  7. Enrollment in conflicting research study
  8. Patients in acute liver failure
  9. Acute kidney injury preoperatively
  10. Diagnosis of pheochromocytoma
  11. Active carcinoid syndrome
  12. Severe audiovisual impairment
  13. Non-English speaking

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Firedobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Placebo komparator: Control

Prepared intravenous piggyback solution of 5 percent dextrose water at multiple postoperative time points over a 30-minute infusion period.

Dextrose 5% in water

Eksperimentel: Low-dose Caffeine

Prepared intravenous low-dose caffeine citrate (1.5 mg/kg) at multiple postoperative time points over a 30-minute infusion period.

Low-dose caffeine citrate (1.5 mg/kg)

High-dose Caffeine citrate (3 mg/kg)

Eksperimentel: High-dose Caffeine

Prepared intravenous high-dose caffeine citrate (3 mg/kg) at multiple postoperative time points over a 30-minute infusion period.

Low-dose caffeine citrate (1.5 mg/kg)

High-dose Caffeine citrate (3 mg/kg)

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Delirium
Tidsramme: Day of surgery through afternoon of postoperative day three

Any positive delirium screen (yes/no) as determined by the long-form Confusion Assessment Method (CAM), and supplemented by a validated daily chart review method.

Day of surgery through afternoon of postoperative day three

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Delirium Severity
Tidsramme: Day of surgery through afternoon of postoperative day three

For all participants screened for delirium, the associated severity score will be recorded using the Confusion Assessment Method Long Form Severity Score (CAM-S) (n, 0-19, with higher number indicating more severe delirium)

Day of surgery through afternoon of postoperative day three
Delirium Duration
Tidsramme: Day of surgery through afternoon of postoperative day three

The cumulative number of days (n) with a positive delirium screen will be calculated for all participants

Day of surgery through afternoon of postoperative day three
Patient-Reported Quality of Recovery
Tidsramme: Preoperative baseline through postoperative day three afternoon

Assessed via the 15-item Quality of Recovery Score (n, 0-150, with higher number indicating better quality of recovery from the patient perspective)

Preoperative baseline through postoperative day three afternoon
Sedation
Tidsramme: Preoperative baseline through postoperative day three afternoon

Any positive screen based on the Richmond Agitation Sedation Scale (RASS; n, -5 to +4). Scores from -5 to -2 will count as a positive screen for sedation.

Preoperative baseline through postoperative day three afternoon
Agitation
Tidsramme: Preoperative baseline through postoperative day three afternoon

Any positive screen based on the Richmond Agitation Sedation Scale (RASS; n, -5 to +4). Scores from +2 to +4 will count as a positive screen for agitation

Preoperative baseline through postoperative day three afternoon
Headache
Tidsramme: Preoperative baseline through postoperative day three afternoon

Headache severity will be assessed via 10-centimeter visual analog scale (0-100 mm, with higher score indicating more severe headache)

Preoperative baseline through postoperative day three afternoon
Cumulative Opioid Consumption
Tidsramme: Day of surgery through postoperative day three afternoon

Postoperative opioid consumption, oral morphine equivalents (mg)

Day of surgery through postoperative day three afternoon

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Anesthetic Emergence
Tidsramme: Duration of time from surgical dressing completion to anesthetic emergence (min); generally expected to be between 10 and 60 minutes

Time (minutes) from surgical closure to extubation

Duration of time from surgical dressing completion to anesthetic emergence (min); generally expected to be between 10 and 60 minutes
Pulmonary Complications
Tidsramme: From extubation until end of postanesthesia care unit stay

Composite outcome (yes/no) of any of the following: airway adjunct use, unplanned continuous positive airway pressure device, unplanned humidified high-flow oxygen, need for bag-mask ventilation, or reintubation

From extubation until end of postanesthesia care unit stay
Hospital Length of Stay
Tidsramme: Morning of surgery until day of hospital discharge, up to 30 days

Total number of days (n) spent in the hospital, up to 30 days

Morning of surgery until day of hospital discharge, up to 30 days
Discharge Disposition
Tidsramme: Day of hospital discharge, up to 30 days

Proportion of patients in each group (%) discharged somewhere other than home (e.g., Long-Term Care Facility), up to 30 days

Day of hospital discharge, up to 30 days
30-Day Cognitive Function
Tidsramme: 30 days after hospital discharge

Cognitive function score based on the Montreal Cognitive Assessment (n, 0-30, with higher scores reflecting higher cognitive function)

30 days after hospital discharge
30-Day Physical Function
Tidsramme: 30 days after hospital discharge

Physical function score based on the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function 10a score (n, 10-50, with higher score indicating better physical function)

30 days after hospital discharge

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Phillip Vlisides, MD, Assistant Professor of Anesthesiology

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

20. februar 2023

Primær færdiggørelse (Faktiske)

16. april 2026

Studieafslutning (Faktiske)

20. maj 2026

Datoer for studieregistrering

Først indsendt

6. oktober 2022

Først indsendt, der opfyldte QC-kriterier

6. oktober 2022

Først opslået (Faktiske)

10. oktober 2022

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

10. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

5. november 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • HUM00218290
  • R01AG075005 (U.S. NIH-bevilling/kontrakt)

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

JA

IPD-planbeskrivelse

Clinical and electroencephalographic data will be preserved and made available for sharing. Data will be saved in various formats, such as comma-separated values (CSV), open document format (ODF), and European Data Format (EDF) for waveform data. Software programs designed to accommodate electroencephalographic waveform data (e.g., MATLAB) will be required for data access and analysis. Specific software and coding recommendations can be made available upon data sharing request.

Any data not permitted to be shared, as specified in written informed consent documents, will be withheld. Likewise, no data will be shared that may compromise the safety or privacy of participants, and no data will be shared that would violate local, state, or federal laws or policies (including the Health Insurance Portability and Accountability Act). All data will be de-identified.

IPD-delingstidsramme

Scientific data will be made available after primary trial manuscripts (for both clinical and electroencephalographic data) are accepted for publication. Data will be made available for as long as possible in compliance with National Institutes of Health and University of Michigan policies.

IPD-delingsadgangskriterier

Data will be shared upon execution of Data Use Agreements in compliance with University of Michigan policies and procedures. Interested researchers will need to contact the study PI (Dr. Vlisides) for obtaining data via Data Use Agreement. All data will be shared upon reasonable request after primary trial manuscripts are published.

IPD-deling Understøttende informationstype

  • STUDY_PROTOCOL
  • SAP
  • ICF

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ja

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

produkt fremstillet i og eksporteret fra U.S.A.

Ingen

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