Outcomes Study of Hyperinsulinemic Glucose Control in Cardiac Surgery
The Effect of Hyperinsulinemic Glucose Control on Outcomes Following Cardiac Surgery
調査の概要
状態
条件
詳細な説明
Using a randomized, controlled design, we propose to test the primary hypothesis that normalization of blood glucose using a hyperinsulinemic-normoglycemic clamp technique reduces the risk of a composite outcome (one or more) of 30-day postoperative mortality and serious postoperative cardiac, renal, neurologic, and infectious postoperative complications in patients undergoing cardiac surgery.
Our secondary hypothesis is that hyperinsulinemic normoglycemic therapy will reduce length of stay in intensive care unit, atrial dysrhythmias, creatinine elevation, hospital readmission, all-cause and cardiac one-year mortality.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Age 18-90 years old
- Scheduled for cardiac surgery requiring cardiopulmonary bypass
Exclusion Criteria:
- Off-pump surgical procedures
- Anticipated deep hypothermic circulatory arrest
- In available, baseline cardiac troponin I (>0.5 ng/L) or troponin T (> 0.1 ng/mL) levels (at RVH or CC, respectively)
- Any contraindications to the proposed interventions
- Active infection, including patients with endocarditis or infected pacemaker leads.
- Any infection requiring long- term antibiotics ( > 14 days)
- kidney disease requiring renal replacement therapy
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:防止
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:Hyperinsulinemic-normoglycemic clamp
Patients will be randomized to receive the hyperinsulinemic-normoglycemic clamp titrating the blood glucose to 80-110 mg/dL.
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Patients will be randomized to receive the hyperinsulinemic-normoglycemic clamp titrating the blood glucose to 80-110 mg/dL.
他の名前:
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他の:Insulin at the standard of care levels
Group B will be administered insulin at the standard of care levels established by the participating institution.
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Subjects will be administered insulin at the standard of care levels established by the participating institution.
他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Any Major Morbidity/30-day Mortality
時間枠:within 30 days post surgery
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a composite (any versus none) of the following major postoperative complications occurring:
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within 30 days post surgery
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Post Operative Atrial Fibrillation
時間枠:15 - 30 days post operative
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Evidence suggests that maintaining intra-operative normoglycemia during cardiac surgery while providing exogenous glucose and high-dose insulin may decrease post-operative morbidity or mortality.
Using a randomized, controlled design, we propose to test the primary hypothesis that normalization of blood glucose using a hyperinsulinemic-normoglycemic clamp technique reduces the risk of a composite of serious adverse outcomes in patients undergoing cardiac surgery
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15 - 30 days post operative
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Duration of Hospitalization
時間枠:starting post operative day one to discharge from hospital, on an average of 8 days
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Days from date of surgery to hospital discharge
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starting post operative day one to discharge from hospital, on an average of 8 days
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Duration of Intensive Care Stay
時間枠:ICU stay hours during hospital stay after surgery, on average of 25 hours
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Hours from date of surgery to discharge from intensive care unit
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ICU stay hours during hospital stay after surgery, on average of 25 hours
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All-cause Mortality
時間枠:one year post operative
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All-cause mortality identified during one-year follow-up.
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one year post operative
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a Composite of Minor Postoperative Complications
時間枠:within 30 days after surgery
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a composite of minor postoperative complications, which includes: a) prolonged mechanical ventilation, b) low cardiac index, c) acute kidney injury, d) prolonged hospitalization, and 3) all-cause hospital readmission within 30 days.
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within 30 days after surgery
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協力者と研究者
スポンサー
捜査官
- スタディディレクター:Daniel I Sessler, M.D.、The Cleveland Clinic
- 主任研究者:Andra I Duncan, M.D.、The Cleveland Clinic
- 主任研究者:Thomas Schricker, MD、Royal Victoria Hospital, Montreal, Canada
- 主任研究者:George Carvalho, MD、Royal Victoria Hospital, Montreal, Canada
出版物と役立つリンク
一般刊行物
- Albacker TB, Carvalho G, Schricker T, Lachapelle K. Myocardial protection during elective coronary artery bypass grafting using high-dose insulin therapy. Ann Thorac Surg. 2007 Dec;84(6):1920-7; discussion 1920-7. doi: 10.1016/j.athoracsur.2007.07.001.
- Duncan AE, Kateby Kashy B, Sarwar S, Singh A, Stenina-Adognravi O, Christoffersen S, Alfirevic A, Sale S, Yang D, Thomas JD, Gillinov M, Sessler DI. Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery: A Randomized Trial. Anesthesiology. 2015 Aug;123(2):272-87. doi: 10.1097/ALN.0000000000000723.
- Schricker T, Sato H, Beaudry T, Codere T, Hatzakorzian R, Pruessner JC. Intraoperative maintenance of normoglycemia with insulin and glucose preserves verbal learning after cardiac surgery. PLoS One. 2014 Jun 18;9(6):e99661. doi: 10.1371/journal.pone.0099661. eCollection 2014.
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- 07-470
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
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心臓手術の臨床試験
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Dong Yangわからない腹腔鏡補助下手術 | 切開を行わない全腹腔鏡手術(Natural Orifice Transluminal Endoscopic Surgery、NOSES)中国