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Piattaforma canadese sull'efficacia comparativa delle cure critiche (CEPEC)

6 novembre 2026 aggiornato da: Université de Sherbrooke

Piattaforma canadese di efficacia comparativa per l'assistenza critica (e) d'Évaluation Clinique Comparée en Soins Critiques (CEPEC)

The Canadian Critical Care Comparative Effectiveness Platform(e) d'Évaluation Clinique Comparée en soins Critiques (CEPEC) is an international multi-centered randomized adaptive platform clinical trial. CEPEC will evaluate supportive care interventions that are used routinely in intensive care units throughout the world.

Panoramica dello studio

Stato

Reclutamento

Condizioni

Intervento / Trattamento

Descrizione dettagliata

Many supportive therapies used daily in the ICU setting remain under-studied despite being resource-intensive. CEPEC aims to incorporate domains evaluating vasopressors and inotropes, nutrition, transfusions, sedation, correction of electrolyte deficits, sedation and analgesia, airway management, end-of-life care practices and other interventions.

Domains refer to categories of patient care for which interventions are being evaluated in a randomized controlled trial (RCT) within the platform.

VASOPRESSOR DOMAIN The investigators will investigate whether vasoactive medications should be used differently for different subgroups of patients who are in a state of cardiovascular shock (i.e. heterogeneity of treatment effects). Vasoactive medications are common in critically ill patients, and have considerable patient, hospital, and health system resource impact, but their use remains poorly supported by scientific evidence.

PLATELET DOMAIN Platelet transfusions are commonly prescribed to critically ill patients and have considerable patient, hospital, and health system resource impact, but remain poorly supported by scientific evidence. We propose to join a multicentre randomized clinical trial (T4P, ISRCTN79371664) addressing the optimal use of platelet transfusions for critically ill patients with thrombocytopenia in advance of invasive procedures. A multinational collaboration will ensure timely completion of this high-impact multicentre randomized clinical trial. The Canadian component of the T4P trial is embedded in the CEPEC platform as the Platelet Domain.

NUTRITION DOMAIN Most critically ill patients cannot eat normally and require a specialized method of feeding, called enteral nutrition. It is provided every hour around the clock. This differs from how we usually eat, with meals (boluses) divided over the day while we are awake. The goals of this study are to determine if a large study can be successfully done comparing nutrition given 3 times a day (boluses) compared to given in small amounts every hour (continuously).

INITIATIVES Initiatives are cross-cutting non-randomized studies nested within the platform that are relevant to all domains. Examples include a parallel observational study initiative, which aims to collect data about usual care and outcomes directly relevant to each domain. The goal is to describe the representativeness of domain results and to assess for protocol misalignment. Similarly, the living knowledge synthesis and health economics initiatives aim to generate meta-analyses and cost-effectiveness analyses alongside each trial conducted in the platform.

Tipo di studio

Interventistico

Iscrizione (Stimato)

5500

Fase

  • Fase 3

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Luoghi di studio

    • New Brunswick
      • Moncton, New Brunswick, Canada, E1C 2Z3
        • Reclutamento
        • Centre hospitalier universitaire Dr-Georges-L.-Dumont
        • Contatto:
        • Investigatore principale:
          • Rémi Leblanc
    • Ontario
      • Hamilton, Ontario, Canada, L8L 2X2
        • Reclutamento
        • Hamilton General Hospital
        • Contatto:
        • Investigatore principale:
          • Kimia Honarmand
      • Hamilton, Ontario, Canada, L8V 1C3
        • Reclutamento
        • Hamilton Health Sciences - Juravinski Hospital
        • Contatto:
        • Investigatore principale:
          • Bram Rochwerg
      • Ottawa, Ontario, Canada, K1H 8L6
        • Reclutamento
        • The Ottawa Hospital
        • Contatto:
        • Investigatore principale:
          • Alexandre Tran
      • Scarborough Village, Ontario, Canada, M1P 2V5
        • Reclutamento
        • Scarborough Health Network
        • Contatto:
          • Joshua Craig
          • Numero di telefono: 416-438-2911
          • Email: jcraig@shn.ca
        • Investigatore principale:
          • Christopher Yarnell
      • St. Catharines, Ontario, Canada, L2S 0A9
        • Reclutamento
        • Niagara Health
        • Investigatore principale:
          • Jennifer Tsang
        • Contatto:
      • Toronto, Ontario, Canada, M4N 3M5
        • Reclutamento
        • Sunnybrook Health Sciences Centre
        • Contatto:
        • Investigatore principale:
          • Neill Adhikari
    • Quebec
      • Longueuil, Quebec, Canada, J4V 2H1
        • Reclutamento
        • Hôpital Charles-Le Moyne
        • Contatto:
        • Investigatore principale:
          • Dany Burke
      • Montreal, Quebec, Canada, H2X 0C1
        • Reclutamento
        • Centre hospitalier de l'Université de Montréal (CHUM)
        • Contatto:
        • Investigatore principale:
          • Francois-Martin Carrier
      • Montreal, Quebec, Canada, H4J 1C5
        • Reclutamento
        • CIUSSS NIM - Hôpital du Sacré-Coeur-de-Montréal
        • Contatto:
        • Investigatore principale:
          • Yiorgos Alexandros Cavayas
      • Sherbrooke, Quebec, Canada, J1H 5N4
        • Reclutamento
        • CIUSSS de l'Estrie - CHUS
        • Contatto:
        • Investigatore principale:
          • Francois Lamontagne
        • Contatto:
      • Auckland, Nuova Zelanda
        • Non ancora reclutamento
        • Auckland City Hospital
      • London, Regno Unito
        • Non ancora reclutamento
        • Intensive Care National Audit and Research Centre (coordinating centre for sites in UK. Sites to be determined)

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

18 anni e precedenti (Adulto, Adulto più anziano)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

VASOPRESSOR DOMAIN There is no minimum age limit in the Vasopressor Domain.

Inclusion criteria:

  1. Ongoing vasopressor infusion to treat hypotension, or would be used to treat clinician-defined hypotension as part of usual care;
  2. MAP <75 mmHg at any point;
  3. Patient expected to be in the ICU for >24 hours.

Exclusion criteria:

  1. Treating team does not have equipoise for at least two contiguous MAP target ranges in the CEPEC Vasopressor Domain;
  2. Acute traumatic brain injury (within 7 days or ongoing active treatment for elevated intracranial pressure);
  3. Acute subarachnoid hemorrhage (within 21 days);
  4. Acute spinal cord injury (within 7 days of injury or ongoing vasopressor therapy for suspected spinal cord ischemia);
  5. Lung, heart, liver, kidney transplant recipient (within 7 days);
  6. Patient expected to become an organ donor (Donor Neurologic Death - DND or Donation After Circulatory Death - DCD);
  7. More than 24 hours since meeting inclusion criteria in the ICU;
  8. Previously randomized into the CEPEC Vasopressor Domain or a confounding trial.

PLATELET DOMAIN

Inclusion criteria:

  1. Adult patients (age ≥18 years) admitted to the ICU;
  2. Latest platelet count in this hospital admission <50×109/L;
  3. Planned to undergo a specified low-moderate bleeding risk invasive procedure.

Exclusion criteria:

  1. Ongoing major hemorrhage requiring blood products and/or surgical/ radiological intervention;
  2. Intracranial hemorrhage within prior 72 hours;
  3. Contraindications to platelet transfusion (e.g. thrombotic microangiopathies, heparin-induced thrombocytopenia, recent history of immune thrombocytopaenia, congenital platelet function defects);
  4. Known advance decision of refusing blood/blood component transfusions;
  5. Acute promyelocytic leukemia (APML);
  6. Death perceived as imminent or admission for palliation;
  7. Previously randomized into the CEPEC Platelet Domain or the T4P Trial;
  8. Fulfilled all the inclusion criteria and none of the exclusion criteria ≥72 hours.

NUTRITION DOMAIN

Inclusion criteria:

  1. Patient of ≥18 years of age;
  2. Patient is invasively mechanically ventilated (including endotracheal tube or tracheostomy);
  3. Orogastric/nasogastric tube in place; or have an in dwelling percutaneous gastric tube (with confirmed placement);
  4. Treating team has started or has the intention of providing enteral nutrition.

Exclusion criteria:

  1. Patient who has had gastrointestinal (GI) surgery in the last 3 months and deemed not ready to receive possible bolus nutrition;
  2. Bowel obstruction or ischemia; active;
  3. Has a post-pyloric small bowel feeding tube;
  4. Active GI bleeding;
  5. Patient who is chronically receiving enteral nutrition.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Altro: Vasopressor

Participants will receive vasopressor(s) and their mean arterial pressure will be titrated according to the group they are randomized to (group 1: 56-60 mmHg; group 2: 61-65 mmHg; group 3: 66-70 mmHg; group 4: 71-75 mmHg). Physicians will have the liberty of restricting the randomization to at least 2 contiguous ranges.

Vasopressor(s) will be titrated according to 56-60 range.

Vasopressor(s) will be titrated according to 61-65 range.

Vasopressor(s) will be titrated according to 66-70 range.

Vasopressor(s) will be titrated according to 71-75 range.

Altro: Platelet

Thrombocytopenic intensive care unit (ICU) patients (platelet count <50×109/L) with a planned low-moderate bleeding-risk procedure will be randomized to one of five equally spaced platelet thresholds (less than 10 x 109/L, less than 20 x 109/L, less than 30 x 109/L, less than 40 x 109/L, less than 50 X 109/L) below which they will receive prophylactic platelet transfusions before any low-moderate bleeding-risk procedure occurring during the ICU episode up to ICU day 90. Once randomized, the clinical team will administer a platelet transfusion according to the assigned threshold and the most recent platelet count at the time of the planned procedure.

Once randomized, the participant will receive a platelet transfusion if their most recent platelet count is less than 10 x 109/L at the time of the planned procedure.

Once randomized, the participant will receive a platelet transfusion if their most recent platelet count is less than 20 x 109/L at the time of the planned procedure.

Once randomized, the participant will receive a platelet transfusion if their most recent platelet count is less than 30 x 109/L at the time of the planned procedure.

Once randomized, the participant will receive a platelet transfusion if their most recent platelet count is less than 40 x 109/L at the time of the planned procedure.

Once randomized, the participant will receive a platelet transfusion if their most recent platelet count is less than 50 x 109/L at the time of the planned procedure.

Altro: Nutrition

The intervention is bolus feeding (given 3 times a day to meet nutritional targets) with formula type left to the discretion of the precribing team. With 2 hours between each "feed".

The control is continuous feeding (over 24-hour period) with formula type left to the discretion of the prescribing team, which is the current standard of care.

Given 3 times a day.

Given over 24-hour period

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Platelet Domain - All cause mortality
Lasso di tempo: 90 days

90-day all-cause mortality

90 days
Nutrition Domain - Recruitment rate
Lasso di tempo: 1 year

Recruitment rate of 2 patients per site per month.

1 year
Vasopressor Domain - 30-day ordinal outcome
Lasso di tempo: At hospital discharge up to day 30

Incorporate mortality, persistent organ dysfunction (POD) in the ICU, hospitalization, discharge to a location providing more health services than at the patient's baseline residence, and discharge to baseline level residence.

At hospital discharge up to day 30

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Dominio piastrinico - mortalità a scarico dall'ospedale
Lasso di tempo: Scarico dall'ospedale
Scarico dall'ospedale
Dominio piastrinico - mortalità a 1 anno
Lasso di tempo: 1 anno dopo la randomizzazione
1 anno dopo la randomizzazione
Dominio piastrinico - esiti sanguinanti in ospedale (sanguinamenti maggiori e fatali)
Lasso di tempo: Durante il ricovero in ospedale
Durante il ricovero in ospedale
Dominio piastrinico - Giorni in vita e a casa al giorno 90
Lasso di tempo: 90 giorni
90 giorni
Platelet Domain - Transfusion complications
Lasso di tempo: During hospitalization

Transfusion-associated circulatory overload, transfusion-related acute lung injury, infections, anaphylaxis

During hospitalization
Platelet Domain - Health-related quality of life
Lasso di tempo: 90 days

Evaluated using EQ-5D-5L questionnaire

90 days
Nutrition Domain - Diarrhea
Lasso di tempo: 24 hours

Defined by the World Health Organization (WHO) definition (3 or greater liquids stools/24 hours)

24 hours
Nutition Domain - Percentage of target nutritional intake
Lasso di tempo: Over the course of the ICU stay up to day 30

>80%

Over the course of the ICU stay up to day 30
Nutrition Domain - Vomiting
Lasso di tempo: During ICU stay up to day 30

Vomiting 2 or more times in a 24-hour period

During ICU stay up to day 30
Vasopressor, Platelet and Nutrition Domains - Each component of the 30-day ordinal primary outcome
Lasso di tempo: At hospital discharge up to day 30
  1. Mortality
  2. POD in the ICU
  3. Hospitalization
  4. Discharge to a location providing more health services than at the patient's baseline residence
  5. Discharge to baseline level residence.
At hospital discharge up to day 30
Vasopressor, Platelet and Nutrition Domains - Days free of POD to day 30
Lasso di tempo: At hospital discharge up to day 30

POD is defined as a vasopressor infusion, invasive mechanical ventilation, non-invasive ventilation, high-flow oxygen (delivered via nasal prongs or cannula by a specialized device, with a FiO2 ≥0.4 and at a flow rate ≥30L/min), or new renal replacement therapy.

At hospital discharge up to day 30
Vasopressor, Platelet and Nutrition Domains - Hospital days up to day 30
Lasso di tempo: Up to day 30
Up to day 30
Vasopressor, Platelet and Nutrition Domains - ICU days to day 30
Lasso di tempo: Up to day 30
Up to day 30
Platelet Domain - Number of days without POD in the ICU
Lasso di tempo: Up to day 90
Up to day 90

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Collaboratori

Investigatori

  • Investigatore principale: Francois Lamontagne, MD, MSc, Université de Sherbrooke
  • Investigatore principale: Neill Adhikari, MDCM, MSc, Sunnybrook Research Institute

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Effettivo)

23 marzo 2025

Completamento primario (Stimato)

31 dicembre 2029

Completamento dello studio (Stimato)

30 giugno 2030

Date di iscrizione allo studio

Primo inviato

10 settembre 2024

Primo inviato che soddisfa i criteri di controllo qualità

17 settembre 2024

Primo Inserito (Effettivo)

20 settembre 2024

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

12 novembre 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

6 novembre 2026

Ultimo verificato

1 ottobre 2026

Maggiori informazioni

Termini relativi a questo studio

Altri numeri di identificazione dello studio

  • MP-31-2025-5600

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

NO

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .