Sedationseffektivitet og sikkerhed af Remifentanil hos ventilerede kirurgiske kritisk syge patienter
Sedationseffektivitet og sikkerhed af remifentanilbesylat hos patienter, der kræver mekanisk ventilation indlagt på intensivafdeling efter elektiv kirurgi: Protokol for et randomiseret, kontrolleret forsøg uden mindreværd
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 4
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Yuefu Wang, doctor
- Telefonnummer: 15301306289 +86
- E-mail: wangyuefu3806@bjsjth.cn
Undersøgelse Kontakt Backup
- Navn: Dandan Liu, doctor
- Telefonnummer: 13810589291 +86
- E-mail: ldd3967@163.com
Studiesteder
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Beijing Municipality
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Beijing, Beijing Municipality, Kina, 100038
- Rekruttering
- Beijing Shijitan Hospital.CMU
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
Tager imod sunde frivillige
Beskrivelse
Inklusionskriterier:
- 18-64 år
- skal acceptere ikke-kardial elektiv kirurgi
- skal under generel anæstesi
- kan kombineres regional vævsbedøvelse
- skal indlægges på intensivafdeling med tracheal intubation efter generel anæstesi - forventet mekanisk ventilationstid skal være mere end 24 timer
- let eller moderat sedation skal være nødvendig
Ekskluderingskriterier:
- intrakraniel kirurgi eller alvorlig neurologisk eller rygmarvssygdom
- skizofreni, epilepsi og Parkinsons sygdom
- koma, svær demens eller sprogbarriere før operationen
- hjertedysfunktion eller arytmi
- alvorlig leverdysfunktion (Child-Pugh C klasse)
- alvorlig nyresvigt
- brug af dexmedetomidin eller remifentanilbesylat 24 timer før eller under operationen
- graviditet eller amning
- enhver forsøgsmedicinsk brug 30 dage før operationen
- nægte at deltage.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Firedobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
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Eksperimentel: remimazolam besylate group
Upon ICU admission, remimazolam besylate infusion will initiated for light sedation maintenance at a dose range of 0.1 to1.0mg/Kg/h.
The target sedation depth is defined as a RASS score of 0 to -2.
The RASS score will evaluated and recorded hourly, and the infusion rate of remimazolam besylate will titrated( increased or decreased) accordingly to maintain the patient within the target sedation range.
For multimodal analgesia, remifentanil will co-administered continuously at a dose of 0.1 to 0.5ug/Kg/min to ensure a CPOT score of 2 or less.
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patients will be sedated with remimazolam via intravenous pump on the day of ICU admission, the dosage will titrate with the depth of sedation evaluated with RASS.
If the target sedation depth could not to achieved within the prespecified maximum dose range of remimazolam, a standardized rescue sedation protocol will intiated as follows: an intravenous bolus of propofol at 0.2mg/kg will administered.
Sedation depth will evaluated 5 minutes post-injection.
The identical dose of propofol bolus will repeated until the desired sedation depth is reached.
Continuous propofol infusion will initiated after three consecutive bolus injections of propofol.
The continuous propofol infusion rate will titrated within the range of 0.2 to 1.0 mg/kg/h until the satisfactory target sedation depth is established.
At the subsequent hourly sedation assessment, continuous propofol infusion will discontinued once the patient successfully maintained a stable RASS score within the 0 to -2 range.
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Aktiv komparator: Dexmedetomidine hydrochloride group
Upon ICU admission, dexmedetomidine infusion will initiated for light sedation maintenance at a dose range of 0.2 to0.7ug/Kg/h.
The target sedation depth is defined as a RASS score of 0 to -2.
The RASS score will evaluated and recorded hourly, and the infusion rate of dexmedetomidine will titrated( increased or decreased) accordingly to maintain the patient within the target sedation range.
For multimodal analgesia, remifentanil will co-administered continuously at a dose of 0.1 to 0.5ug/Kg/min to ensure a CPOT score of 2 or less.
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patients will be sedated with dexmedetomidine hydrochloride via intravenous pump on the day of ICU admission, the dosage will titrate with the depth of sedation evaluated with RASS.
If the target sedation depth could not to achieved within the prespecified maximum dose range of remimazolam, a standardized rescue sedation protocol will intiated as follows: an intravenous bolus of propofol at 0.2mg/kg will administered.
Sedation depth will evaluated 5 minutes post-injection.
The identical dose of propofol bolus will repeated until the desired sedation depth is reached.
Continuous propofol infusion will initiated after three consecutive bolus injections.
The continuous propofol infusion rate will titrated within the range of 0.2 to 1.0 mg/kg/h until the satisfactory target sedation depth is established.
At the subsequent hourly sedation assessment, continuous propofol infusion will discontinued once the patient successfully maintained a stable RASS score within the 0 to -2 range.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Percentage of time in optimal sedation
Tidsramme: Through the useage of sedative drugs in the ICU, an average of 3 days
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Percentage of time in optimal sedation during sedation in the ICU, sedation depth is assessed using Richmond Agitation Sedation Scale(RASS, -5 to +4), target sedation must has a RASS score -2 to 0.
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Through the useage of sedative drugs in the ICU, an average of 3 days
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Delirium forekomst
Tidsramme: Gennem intensivopholdet i gennemsnit 3 dage
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Deliriumforekomst under patienternes ICU-ophold, vurderet ved hjælp af Confusion Assessment Method for intensivafdelingen (CAM-ICU, 4 punkter), delirium diagnosticeres når 3 punkter er opfyldt
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Gennem intensivopholdet i gennemsnit 3 dage
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Re-mekanisk ventilationsincidens efter fravænning og ekstubation
Tidsramme: Gennem intensivopholdet i gennemsnit 3 dage
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Re-mekanisk ventilationsincidens efter fravænning og ekstubation
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Gennem intensivopholdet i gennemsnit 3 dage
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ICU TAB
Tidsramme: Den dag patienten flytter ud af intensivafdelingen, i gennemsnit 1 dag
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ICU liggetid
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Den dag patienten flytter ud af intensivafdelingen, i gennemsnit 1 dag
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Ventilation free days
Tidsramme: Through the initiation of enrollment to 28 days, an average of 1 day
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Ventilation free days(VFDs) at 28 days.
VFDs=0 if subject dies within 28 days of mechaincal ventilation; VFDs=28-X if successfully liberated from ventilation X days after initiation,if the patient is reintubated within 28 days, "X" represents the days of the last extubation; VFDs=0 if the subject is mechaincally ventilated for >28 days.
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Through the initiation of enrollment to 28 days, an average of 1 day
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Dosage of rescue sedatives
Tidsramme: Through the useage of sedative drugs in the ICU, an average of 3 days
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Dosage of rescue sedatives during mechanical ventilation in the ICU
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Through the useage of sedative drugs in the ICU, an average of 3 days
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Frequency of rescue sedatives
Tidsramme: Through the useage of sedative drugs in the ICU, an average of 3 days
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Frequency of rescue sedatives during mechanical ventilation in the ICU
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Through the useage of sedative drugs in the ICU, an average of 3 days
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post-sedation extubation time
Tidsramme: From ICU admission to extubation, an average of 3 days
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Extubation time(hour) after termination of sedation
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From ICU admission to extubation, an average of 3 days
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Proportion of different oxygen therapies post-extubation
Tidsramme: Through the ICU stay, an average of 3 days
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Proportion of different oxygen therapies post-extubation
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Through the ICU stay, an average of 3 days
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Pain scores during the first 3 postoperative days
Tidsramme: The first 3 days of ICU stay, an average of 3 days
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Pain scores during the first 3 postoperative days, assessed using Critical-Care Pain Observation Tool(CPOT,0-8), the higher the score, the more painful the patient feels
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The first 3 days of ICU stay, an average of 3 days
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Sleep quality scores on the day of ICU discharge
Tidsramme: The day transfer out of ICU, an average of 1day
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Sleep quality scores on the day of ICU discharge, assessed using St.Mary'sHospitalSleepQuestionnaire(SMHSQ, 11 to 55), the lower the score, the higher the degree of sleep disorders
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The day transfer out of ICU, an average of 1day
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Cognitive assessment scores on postoperative day 60
Tidsramme: Day 60 after surgery, an average of 1 day
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Cognitive assessment scores on postoperative day 60, assessed using Telephone Interview for Cognitive Status-Modified(TICS-m,0-50), the higher the score, the better the cognitive function
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Day 60 after surgery, an average of 1 day
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Sleep quality scores on postoperative day 60
Tidsramme: Day 60 after surgery, an average of 1 day
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Sleep quality scores on postoperative day 60 assessed using Pittsburgh sleep quality index(PSQI,0-21), the higher the score, the worse the sleep quality
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Day 60 after surgery, an average of 1 day
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Postoperative hospital LOS
Tidsramme: The day the patient discharge, an average of 1 day
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postoperative hospital length of stay
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The day the patient discharge, an average of 1 day
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60-day all-cause mortality
Tidsramme: Day 60 postoperative, an average of 1 day
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60-day all-cause mortality
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Day 60 postoperative, an average of 1 day
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60-day non-neurological complications
Tidsramme: Day 60 postoperative, an average of 1 day
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60-day non-neurological complications
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Day 60 postoperative, an average of 1 day
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Studiestol: Jianxin Zhou, doctor, Beijing Shijitan Hospital, Capital Medical University
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- IIT2024-001-002
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