Studio della pressione interstiziale sottocutanea durante la sepsi (PISEP)
The pathophysiology of sepsis is characterized by the sudden onset of vasodilation and vascular permeability with capillary leakage. This leakage contributes to the development of generalized edema which is not clinically detectable below 4 litres but which becomes visible after a few days. The edema accumulates mainly at the subcutaneous level due to the high compliance of this tissue. Edema, and therefore hydrosodium overload, testifies to the severity of the inflammation. However, it could also be harmful in itself (affecting microcirculation and increasing mortality) as suggested by numerous clinical and experimental studies.
The transfer of fluids between vascular and interstitial compartments during sepsis therefore has a central role in the pathophysiology of the disease and associated mortality. These transfers are mainly controlled at the microvascular level (with constant permeability) by the difference between capillary (CP) and interstitial (IP) pressures. In healthy subjects, subcutaneous IP is discreetly negative (-1 mmHg) and varies very little. On the other hand, a sometimes drastic decrease in IP has been described in various localized and systemic inflammatory situations. These pressure variations may be explained by the collagen structure of the interstitial tissue and a change in the three-dimensional conformation of these macromolecules induced by inflammation mediators. In an animal model of sepsis, a study showed significantly lower pressure in a group of animals in endotoxic shock. IP has never been measured in humans during sepsis. The objective of this study is to analyze subcutaneous IP (SCIP) in patients with septic shock compared with controls in order to evaluate the direct role of interstitial tissue in the onset of edema during sepsis.
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Tipo di studio
Iscrizione (Effettivo)
Fase
- Non applicabile
Contatti e Sedi
Luoghi di studio
-
-
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Dijon, Francia, 21079
- CHU de DIJON
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Lyon, Francia, 69003
- HCL - Hôpital Edouard Herriot
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
Criteria common to both groups:
- Adult,
- Admitted within the last 24 hours in intensive care,
- Under mechanical ventilation with orotracheal intubation,
- Without clinically detectable edema (in any area)
- Patient and/or guardian and/or close relative has given written consent
Patients included in the "septic shock" arm:
- Diagnosis of septic shock as defined by the "Sepsis-3" Consensus Conference (JAMA 2016) (34): documented or highly suspected infection with SOFA ≥ 2, persistent hypotension after correction of hypovolemia requiring vasopressor administration, and serum lactate > 2 mmol/l.
- Vascular filling < 50 ml/kg
Patients included in the control arm:
-
Absence of sepsis and shock from any cause:
- PAS > 100 mmHg
- Absence of vasopressors
- Preserved urine > 0.5 ml/kg/h
- Normal serum lactate
-
Crystalloid infusions < 50ml/kg over the previous 12 hours
Exclusion Criteria:
- not affiliated to national health insurance
- under court protection
- pregnant or breastfeeding
- Clinical disseminated intravascular coagulation (DIC) with hemorrhagic syndrome
- Admitted after resuscitation for cardiac arrest
- Presenting cardiogenic shock
- Presenting acute pancreatitis
- Severe overall dehydration (clinical signs of dehydration and natremia > 150mmol/l)
- Presenting metformin intoxication
- In severe sepsis or septic shock for more than 24 hours,
- Dying or for whom death seems imminent (within 24 hours),
- Hypersensitivity to lidocaine and/or prilocaine or local anesthetics of the amide type or to any of the excipients of EMLAPATCH®
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Scienza basilare
- Assegnazione: Non randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
|
Altro: Controllo
|
Subcutaneous interstitial measurement at D1 and D2 |
|
Altro: Shock settico
|
Subcutaneous interstitial measurement at D1 and D2 |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Value of Initial subcutaneous interstitial pressure
Lasso di tempo: Day 0
|
Measure the difference between the subcutaneous interstitial pressure of patients in septic shock compared to patients without sepsis |
Day 0
|
Collaboratori e investigatori
Pubblicazioni e link utili
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Completamento primario (Effettivo)
Completamento dello studio (Effettivo)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Altri numeri di identificazione dello studio
- DARGENT 2018
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
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 .