- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT04344730
Dexamethasone and Oxygen Support Strategies in ICU Patients With Covid-19 Pneumonia (COVIDICUS)
Dexamethasone and Oxygen Support Strategies in ICU Patients With Covid-19 pneumonia_COVIDICUS
The main manifestation of COVID-19 is acute hypoxemic respiratory failure (AHRF). In patients with AHRF, the need for invasive mechanical ventilation is associated with high mortality.
Two hypotheses will be tested in this study. The first hypothesis is the benefit of corticosteroid therapy on severe COVID-19 infection admitted in ICU in terms of survival.
The second hypothesis is that, in the subset of patients free of mechanical ventilation at admission, either Continuous Positive Airway Pressure (CPAP) or High-Flow Nasal Oxygen (HFNO) allows to reduce intubation rate safely during COVID-19 related acute hypoxemic respiratory failure.
Studieoversigt
Status
Betingelser
Detaljeret beskrivelse
The main manifestation of COVID-19 is acute hypoxemic respiratory failure (AHRF). In patients with AHRF, the need for invasive mechanical ventilation is associated with high mortality.
Two hypotheses will be tested in this study. The first hypothesis is the benefit of corticosteroid therapy on severe COVID-19 infection admitted in ICU in terms of survival.
The second hypothesis is that, in the subset of patients free of mechanical ventilation at admission, either Continuous Positive Airway Pressure (CPAP) or High-Flow Nasal Oxygen (HFNO) allows to reduce intubation rate safely during COVID-19 related acute hypoxemic respiratory failure.
The main objective is to assess the impact of dexamethasone on overall mortality at day-60 after randomization in patients admitted in ICU for severe COVID-19 infection.
In non mechanical ventilation (MV) patients, the additional objective is to assess whether oxygen support based on either HFNO or CPAP modality in COVID-19 related AHRF reduces the need for mechanical ventilation at day-28.
An ancillary study CACAO (COVIDICUS air contamination) will be performed in 4 centers aiming at assessing the environmental contamination by SARS-CoV-2 according to the oxygen support modality. Additional funding will be searched for these analyses (submitted for ANR call).
A metanalysis on individual data will be performed using patients enrolled in the 3 PHRC flash exploring the activity of corticosteroids.
Undersøgelsestype
Tilmelding (Faktiske)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
-
-
-
Paris, Frankrig, 75018
- Hôpital Bichat - APHP
-
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Age ≥ 18 years
- Admitted to ICU within 48 hours
- Confirmed or highly suspected COVID-19 infection
- Acute hypoxemic respiratory failure (PaO2 <70 mmHg or SpO2<90% on room air or tachypnea>30/min or labored breathing or respiratory distress; need for oxygen flow >=6L/min)
- Any treatment intended to treat the SARS-CoV-2 infection in the absence of contraindications (either as a compassionate use or in the context of a clinical trial, i.e remdesivir, lopinavir/ritonavir, favipiravir, hydroxychloroquine and any other new drug with potential activity).
Non-inclusion Criteria:
- Moribund status
- Pregnancy or breastfeeding
- Long term corticotherapy at a dose of 0.5mg/kg/j or higher
- Active and untreated bacterial, fungal or parasitic infection
- Not Written informed consent from the patient or a legal representative if appropriate . If absence a legal representative the patient may be included in emergency procedure
- hypersensitivity to dexamethasone or to any of the excipients
- Not Affiliation to the French social security
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Faktoriel opgave
- Maskning: Firedobbelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
---|---|
Placebo komparator: Standard oxygen 1
Standard oxygen and placebo of Dexamethasone
|
Box of 10 NaCl 0,9% , solution for injection in ampoule of 5mL.
Each allocated box contains complete treatment from D1 to D10 for one patient.
The oxygen flow will be adjusted to maintain an oxygen saturation level of 92% or more, as measured by means of pulse oximetry (SpO2)
|
Eksperimentel: Standard oxygen 2
Standard oxygen and Dexamethasone
|
The oxygen flow will be adjusted to maintain an oxygen saturation level of 92% or more, as measured by means of pulse oximetry (SpO2)
Box of 10 DEXAMETHASONE 20 mg / 5 ml, solution for injection in ampoule of 5mL.
Each allocated box contains complete treatment from D1 to D10 for one patient.
Andre navne:
|
Eksperimentel: CPAP 1
CPAP and placebo of Dexamethasone
|
Box of 10 NaCl 0,9% , solution for injection in ampoule of 5mL.
Each allocated box contains complete treatment from D1 to D10 for one patient.
Patients assigned to the CPAP plus oxygen group will receive periods of CPAP in addition to the standard treatment.The oxygen flow will be adjusted to maintain an oxygen saturation level of 92% or more, as measured by means of pulse oximetry (SpO2)
|
Eksperimentel: CPAP 2
CPAP and Dexamethasone
|
Box of 10 DEXAMETHASONE 20 mg / 5 ml, solution for injection in ampoule of 5mL.
Each allocated box contains complete treatment from D1 to D10 for one patient.
Andre navne:
Patients assigned to the CPAP plus oxygen group will receive periods of CPAP in addition to the standard treatment.The oxygen flow will be adjusted to maintain an oxygen saturation level of 92% or more, as measured by means of pulse oximetry (SpO2)
|
Eksperimentel: HFNO 1
HFNO and placebo of Dexamethasone
|
Box of 10 NaCl 0,9% , solution for injection in ampoule of 5mL.
Each allocated box contains complete treatment from D1 to D10 for one patient.
TIn the high-flow-nasal cannula group, oxygen will be delivered through a heated humidifier (Airvo-2, Fisher and Paykel Healthcare) and applied continuously through large-bore binasal prongs, with a gas flow rate of 30 liters per minute and adjusted based on the clinical response.
FiO2 will be adjusted for the target SpO2
|
Eksperimentel: HFNO 2
HFNO and Dexamethasone
|
Box of 10 DEXAMETHASONE 20 mg / 5 ml, solution for injection in ampoule of 5mL.
Each allocated box contains complete treatment from D1 to D10 for one patient.
Andre navne:
TIn the high-flow-nasal cannula group, oxygen will be delivered through a heated humidifier (Airvo-2, Fisher and Paykel Healthcare) and applied continuously through large-bore binasal prongs, with a gas flow rate of 30 liters per minute and adjusted based on the clinical response.
FiO2 will be adjusted for the target SpO2
|
Placebo komparator: mechanically ventilated 1
placebo
|
Box of 10 NaCl 0,9% , solution for injection in ampoule of 5mL.
Each allocated box contains complete treatment from D1 to D10 for one patient.
The oxygen flow will be adjusted to maintain an oxygen saturation level of 92% or more, as measured by means of pulse oximetry (SpO2)
|
Eksperimentel: mechanically ventilated 2
Dexamethasone
|
Box of 10 DEXAMETHASONE 20 mg / 5 ml, solution for injection in ampoule of 5mL.
Each allocated box contains complete treatment from D1 to D10 for one patient.
Andre navne:
The oxygen flow will be adjusted to maintain an oxygen saturation level of 92% or more, as measured by means of pulse oximetry (SpO2)
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
The time-to-death from all causes
Tidsramme: day-60
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The time-to-death from all causes within the first 60 days after randomization.
|
day-60
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The time to need for mechanical ventilation (MV)
Tidsramme: day-28.
|
the time to need for mechanical ventilation (MV), as defined by any of the 3 criteria for intubation within the first 28 days after randomization.
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day-28.
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
The viral load in the respiratory tract
Tidsramme: day-10
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The cycle threshold for SARS-CoV-2 PCR at baseline, day 7+/-1 and day 10 +/- in samples of the same origin (preferably subglottic i.e. bronchoalveolar lavage or tracheal aspiration, otherwise nasopharyngeal swab)
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day-10
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Number of patient with at least one episode of healthcare-associated infections
Tidsramme: day-28
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Proportion of patients with at least one episode of any healthcare-associated infection between randomization and D28
|
day-28
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Number of days alive without mechanical ventilation
Tidsramme: day-28
|
To compare the exposition to mechanical ventilation
|
day-28
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Measure of SOFA score
Tidsramme: day-1 to day 3, day 7, day 10, day 21, day 28
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Changes in SOFA (Sepsis-related Organ Failure Assessment) score.
(min = 0 for normal status max = 24 for worse status)
|
day-1 to day 3, day 7, day 10, day 21, day 28
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Number of days alive without renal replacement therapy
Tidsramme: day-28
|
to compare the exposition to renal replacement therapy
|
day-28
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Lengths of ICU-stay
Tidsramme: day-60
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To compare the lengths of ICU
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day-60
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Lengths of hospital-stay
Tidsramme: day-60
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To compare the lengths of hospital-stay
|
day-60
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Number of patients with severe hypoxemia,
Tidsramme: day 60
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Proportion of patients with severe hypoxemia, which is defined as an oxygen saturation of less than 80% during the same interval during the interval between induction and 2 minutes after tracheal intubation
|
day 60
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Proportion of patients with cardiac arrest within 1 hour after intubation
Tidsramme: day 60
|
Proportion of patients with cardiac arrest within 1 hour after intubation
|
day 60
|
Overall survival
Tidsramme: day 60
|
To compare Overall survival after randomization
|
day 60
|
Samarbejdspartnere og efterforskere
Efterforskere
- Ledende efterforsker: Jean François TIMSIT, Pr, Assistance Publique - Hôpitaux de Paris
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Primær færdiggørelse (Forventet)
Studieafslutning (Forventet)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Coronavirus infektioner
- Coronaviridae infektioner
- Nidovirales infektioner
- RNA-virusinfektioner
- Virussygdomme
- Infektioner
- Luftvejsinfektioner
- Luftvejssygdomme
- Respirationsforstyrrelser
- Lungebetændelse, viral
- Lungesygdomme
- COVID-19
- Respiratorisk insufficiens
- Lungebetændelse
- Lægemidlers fysiologiske virkninger
- Autonome agenter
- Agenter fra det perifere nervesystem
- Anti-inflammatoriske midler
- Antineoplastiske midler
- Antiemetika
- Gastrointestinale midler
- Glukokortikoider
- Hormoner
- Hormoner, hormonsubstitutter og hormonantagonister
- Antineoplastiske midler, hormonelle
- Dexamethason
- Dexamethasonacetat
Andre undersøgelses-id-numre
- APHP200388
- 2020-001457-43 (EudraCT nummer)
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .
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