The I-MICRO trial, Ilomedin for treatment of septic shock with persistent microperfusion defects: a double-blind, randomized controlled trial-study protocol for a randomized controlled trial

Abstract

Background: Septic shock remains a significant cause of death in critically ill patients. During septic shock, some patients will retain microcirculatory disorders despite optimal hemodynamic support (i.e., fluid resuscitation, vasopressors, inotropes). Alterations in the microcirculation are a key pathophysiological factor of organ dysfunction and death in septic shock patients. Ilomedin is a prostacyclin analog with vasodilatory effect and anti-thrombotic properties (i.e., inhibition of platelet aggregation) preferentially at the microcirculatory level. We hypothesize that early utilization of intravenous Ilomedin in septic shock patients with clinical persistence of microperfusion disorders would improve the recovery of organ dysfunction.

Methods: The I-MICRO trial is a multicenter, prospective, randomized, double-blinded, placebo-controlled study. We plan to recruit 236 adult patients with septic shock and persistent microcirculatory disorders (i.e., skin mottling or increased capillary refill time) despite hemodynamic support. Participants will be randomized to receive a 48-h intravenous infusion of either Ilomedin or placebo starting at the earliest 6 h and later 24 h after septic shock. The primary outcome will be the change (delta) of sequential organ failure assessment (SOFA) score between randomization and day 7. Secondary outcomes will include mean SOFA score during the first 7 days after randomization, mortality at day 28 post-randomization, number of ventilation-free survival days in the 28 days post-randomization, number of renal replacement therapy-free survival days in the 28 days post-randomization, number of vasopressor-free survival days in the 28 days post-randomization, and mottling score at day 1 after randomization.

Discussion: The trial aims to provide evidence on the efficacy and safety of Ilomedin in patients with septic shock and persistent microcirculatory disorders.

Trial registration: NCT NCT03788837 . Registered on 28 December 2018.

Keywords: Capillary refill time; Iloprost; Microcirculation; Outcome; Prostacyclin; Sepsis; Skin mottling; Vasodilator.

Conflict of interest statement

ML reports consulting fees from Novartis, lecture fees from Baxter and Fresenius, and research support from Shingotec.

HAO declares no conflict of interest

DDB is a consultant to and material for studies by Edwards Lifesciences.

ML declares COIs with Amomed (consulting, lecture), Aguettant (consulting), MSD (consulting, lecture), Pfizer (lecture), Aspen (lecture), Orion (lecture), and Octapharma (lecture).

BL is a member of an advisory board working for Orion Pharma and has received honoraria from the company for his participation in the board and for giving invited lectures at industry symposia.

PR is a co-founder of CardioRenal and declares personal fees (consulting) from Novartis, NovoNordisk, Relypsa, AstraZeneca, Grünenthal, Idorsia, Stealth Peptides, Fresenius, Vifor Fresenius Medical Care Renal Pharma, Vifor, and Clinical Trials Mobile Application, and lecture fees from Bayer and CVRx.

EV declares no conflict of interest.

FD received lecture fees from Sedana medical, a research grant from the French ministry of health.

Figures

Fig. 1

Study design. SOFA score, sequential organ failure assessment score; AE, adverse events; SAE, serious adverse events

Fig. 2

CONSORT flow chart of the study