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Behandeling van ARDS met geïnstilleerde T3 (ARDS+T3)
Fase II gerandomiseerde, interventie versus niet-interventie, multicenter studie van de effecten van schildklierhormoon (T3) op extravasculair longwater (EVLW) bij proefpersonen met acuut ademhalingsnoodsyndroom (ARDS)
It is hypothesized that instillation of Liothyronine Sodium (T3) into the airspace will be safe, well tolerated, and will increase alveolar fluid clearance and decrease inflammation in patients with ARDS, reflected in improved oxygenation index (OI) and oxygenation saturation index (OSI).
Studie Overzicht
Toestand
Gedetailleerde beschrijving
T3 Therapy in ARDS- Phase 2 Randomized, Unblinded, Intervention versus Non- Intervention Trial. Enrollment 68 participants (50 treatment + 18 control). Purpose- To determine the safety and tolerability of T3 delivery into the lungs of ARDS patients, and to measure the effect of T3 on Oxygenation in ARDS patients. Study Drug- Liothyronine Sodium (T3), 50 mcg will be instilled twice daily via a catheter through the ETT into the airway in a total volume of 10 mL (T3+0.9% sodium chloride), over 5 days (10 total doses), or until extubation, whichever comes first.
Studietype
Inschrijving (Werkelijk)
Fase
- Fase 2
Contacten en locaties
Studie Locaties
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Minnesota
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Edina, Minnesota, Verenigde Staten, 55435
- M Health Fairview Southdale Hospital
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Minneapolis, Minnesota, Verenigde Staten, 55455
- East Bank Hospital - M Health Fairview University of Minnesota Medical Center
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
Study population is critically ill patients requiring mechanical ventilatory support for ARDS in an intensive care unit.
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Adults (≥18 years of age).
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Male or female (non-pregnant).
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Clinical diagnosis of ARDS (all are required):
- Onset: <= 7 days.
- Chest x-ray: Bilateral Patchy Opacities, Infiltrates.
- Mechanical Vent Support: PEEP or CPAP Support >= 5 cm H2O.
- Pulmonary Edema: Not fully explained by cardiogenic etiology.
- Hypoxia: PaO2/FIO2 Ratio <300, or O2Sat/FIO2 Ratio <315.
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On mechanical ventilatory support.
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Capable of giving informed consent directly or from the subject's legally authorized representative (LAR) as determined by the site Principal Investigator and/or Sub- Investigators.
Exclusion Criteria:
Patients with any of the following conditions will be excluded from this trial:
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Inadequate medical history for determining inclusion/exclusion criteria, as determined by the Principal Investigator and/or Sub- Investigators.
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Unlikely to complete the protocol with clinic follow-up after discharge, as determined by the Principal Investigator and/or Sub- Investigators or hospice status.
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Prior history of thyroid cancer or hyperthyroidism, per thorough patient/family interviews, review of past medical history, medication list, laboratory test.
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Prior history of cardiovascular disease defined as:
- Hypertensive crisis in the past 3 months (systolic >200, or diastolic >120 mmHg),
- Sustained ventricular arrhythmia in the past 3 months (duration >30 seconds)
- Coronary artery disease (documented >=70% occlusion untreated in any coronary vessel), as per the 2021 ACC/AHA/SCAI Guidelines for Coronary Artery Revascularization.
- Cardiac-related angina pectoris (>=2 episodes in the past 3 months)
- Myocardial infarction with ischemia on ECG (i.e.,new ST- elevation/depression of >1mm in contiguous leads).
- Peripheral vascular disease (documented >=70% occlusion untreated in any peripheral vessel), as per the 2018 ACC/AHA/SCAI/SIR/SVM Guidelines for Appropriate Use Criteria for Peripheral Artery Intervention.
- Decompensated or symptomatic heart failure (i.e., hospitalized for CHF exacerbation, or a change in CHF medications within two weeks prior)
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Currently pregnant or breastfeeding.
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Known allergy to study drug.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Experimenteel: Treatment Arm
Liothyronine Sodium (T3+0.9% sodium chloride) modified formulation specifically for airway instillation. |
Study Drug Administration:
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Ander: Control arm
Standard of Care |
Standard of Care (SOC) |
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Oxygenation: Oxygenation Index (OI), and/or Oxygenation Saturation Index (OSI).
Tijdsspanne: baseline
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To assess the efficacy of airway instilled T3 improving oxygenation by reducing OI and OSI in ARDS patients. OI will be measured by mechanical ventilator (FIO2 and Mean Airway Pressure, MAP), and ABG (PaO2). OSI will be measured by mechanical ventilator (FIO2, SpO2 and MAP): OI = (FIO2 x MAP / PaO2). OSI = (FIO2 x MAP / SpO2). |
baseline
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Oxygenation: Oxygenation Index (OI), and/or Oxygenation Saturation Index (OSI).
Tijdsspanne: 6 hours post-dose
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To assess the efficacy of airway instilled T3 improving oxygenation by reducing OI and OSI in ARDS patients. OI will be measured by mechanical ventilator (FIO2 and Mean Airway Pressure, MAP), and ABG (PaO2). OSI will be measured by mechanical ventilator (FIO2, SpO2 and MAP): OI = (FIO2 x MAP / PaO2). OSI = (FIO2 x MAP / SpO2). |
6 hours post-dose
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Oxygenation: Oxygenation Index (OI), and/or Oxygenation Saturation Index (OSI).
Tijdsspanne: 12 hours post-dose
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To assess the efficacy of airway instilled T3 improving oxygenation by reducing OI and OSI in ARDS patients. OI will be measured by mechanical ventilator (FIO2 and Mean Airway Pressure, MAP), and ABG (PaO2). OSI will be measured by mechanical ventilator (FIO2, SpO2 and MAP): OI = (FIO2 x MAP / PaO2). OSI = (FIO2 x MAP / SpO2). |
12 hours post-dose
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Oxygenation: Oxygenation Index (OI), and/or Oxygenation Saturation Index (OSI).
Tijdsspanne: 24 hours post-dose
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To assess the efficacy of airway instilled T3 improving oxygenation by reducing OI and OSI in ARDS patients. OI will be measured by mechanical ventilator (FIO2 and Mean Airway Pressure, MAP), and ABG (PaO2). OSI will be measured by mechanical ventilator (FIO2, SpO2 and MAP): OI = (FIO2 x MAP / PaO2). OSI = (FIO2 x MAP / SpO2). |
24 hours post-dose
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Oxygenation: Oxygenation Index (OI), and/or Oxygenation Saturation Index (OSI).
Tijdsspanne: 48 hours post-dose
|
To assess the efficacy of airway instilled T3 improving oxygenation by reducing OI and OSI in ARDS patients. OI will be measured by mechanical ventilator (FIO2 and Mean Airway Pressure, MAP), and ABG (PaO2). OSI will be measured by mechanical ventilator (FIO2, SpO2 and MAP): OI = (FIO2 x MAP / PaO2). OSI = (FIO2 x MAP / SpO2). |
48 hours post-dose
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Oxygenation: Oxygenation Index (OI), and/or Oxygenation Saturation Index (OSI).
Tijdsspanne: 72 hours post-dose
|
To assess the efficacy of airway instilled T3 improving oxygenation by reducing OI and OSI in ARDS patients. OI will be measured by mechanical ventilator (FIO2 and Mean Airway Pressure, MAP), and ABG (PaO2). OSI will be measured by mechanical ventilator (FIO2, SpO2 and MAP): OI = (FIO2 x MAP / PaO2). OSI = (FIO2 x MAP / SpO2). |
72 hours post-dose
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Oxygenation: Oxygenation Index (OI), and/or Oxygenation Saturation Index (OSI).
Tijdsspanne: 96 hours post-dose
|
To assess the efficacy of airway instilled T3 improving oxygenation by reducing OI and OSI in ARDS patients. OI will be measured by mechanical ventilator (FIO2 and Mean Airway Pressure, MAP), and ABG (PaO2). OSI will be measured by mechanical ventilator (FIO2, SpO2 and MAP): OI = (FIO2 x MAP / PaO2). OSI = (FIO2 x MAP / SpO2). |
96 hours post-dose
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Oxygenation: Oxygenation Index (OI), and/or Oxygenation Saturation Index (OSI).
Tijdsspanne: 120 hours post-dose
|
To assess the efficacy of airway instilled T3 improving oxygenation by reducing OI and OSI in ARDS patients. OI will be measured by mechanical ventilator (FIO2 and Mean Airway Pressure, MAP), and ABG (PaO2). OSI will be measured by mechanical ventilator (FIO2, SpO2 and MAP): OI = (FIO2 x MAP / PaO2). OSI = (FIO2 x MAP / SpO2). |
120 hours post-dose
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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SOC pressor(en) dosis(en)
Tijdsspanne: basislijn en 5 dagen
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basislijn en 5 dagen
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SOC diuretica dosis(en)
Tijdsspanne: basislijn en 5 dagen
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basislijn en 5 dagen
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Beademingsvrije dagen
Tijdsspanne: basislijn en 5 dagen
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basislijn en 5 dagen
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ICU-vrije dagen
Tijdsspanne: basislijn en 5 dagen
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basislijn en 5 dagen
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Zuurstofvrije dagen
Tijdsspanne: basislijn en 5 dagen
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basislijn en 5 dagen
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Sterfte door alle oorzaken
Tijdsspanne: basislijn en 5 dagen
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basislijn en 5 dagen
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Vereisten voor plaatsing van een tracheostomie
Tijdsspanne: basislijn en 5 dagen
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basislijn en 5 dagen
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TSH, Totaal T3, Gratis T3, Gratis T4
Tijdsspanne: uitgangswaarde en 156 uur na de dosis
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uitgangswaarde en 156 uur na de dosis
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Gratis T3, gratis T4
Tijdsspanne: basislijn en 5 dagen
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basislijn en 5 dagen
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Pulmonary events
Tijdsspanne: baseline and 120 hours post-dose
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Progressive hemoptysis: bright, red blood in streaks, mixed or clots within sputum on suctioning of greater than 30 mL accumulation anytime following the initial and subsequent intratracheal dosing administrations. |
baseline and 120 hours post-dose
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Cardiovascular event 1
Tijdsspanne: baseline to 120hours post-dose
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New sustained ventricular arrhythmia (>30 secs) |
baseline to 120hours post-dose
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Cardiovascular event 2
Tijdsspanne: baseline to 120hours post-dose
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New sustained accelerated junctional arrhythmia (rate >80 bpm) with worsened hypotension (decrease in mean arterial pressure to less than 65mmHg). |
baseline to 120hours post-dose
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Cardiovascular event 3
Tijdsspanne: baseline to 120hours post-dose
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New sustained atrial fibrillation with rapid ventricular response (ventricular rate >160 bpm) with worsened hypotension (decrease in mean arterial pressure to less than 65mmHg). |
baseline to 120hours post-dose
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Cardiovascular event 4
Tijdsspanne: baseline to 120hours post-dose
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Cardiac arrest (pulseless electrical activity, or asystole). |
baseline to 120hours post-dose
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Cardiovascular event 5
Tijdsspanne: baseline to 120hours post-dose
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Hypertensive crisis (systolic pressure of 180 mmHg (or higher), or diastolic pressure of 120 mmHg (or higher) or change in MAP > 20 mmHg with three consecutive measurements over 30 minutes). |
baseline to 120hours post-dose
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SOC pulmonary vasodilator
Tijdsspanne: baseline and 5 days
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yes or no |
baseline and 5 days
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Supplemental oxygen on discharge
Tijdsspanne: baseline and 5 days
|
yes or no |
baseline and 5 days
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Discharge disposition
Tijdsspanne: baseline and 5 days
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home, inpatient rehabilitation, long-term acute care hospital (LTACH) |
baseline and 5 days
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Studie stoel: David H Ingbar, MD, University of Minnesota
- Studie directeur: Timothy P Rich, MD, University of Minnesota
- Hoofdonderzoeker: Ronald A Reikoff, MD, University of Minnesota
Publicaties en nuttige links
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
- Endocriene systeemziekten
- Luchtweginfecties
- Infecties
- Ziekten van de luchtwegen
- Longziekten
- Ademhalingsstoornissen
- Schildklier Ziekten
- Ademnoodsyndroom
- Longoedeem
- Longontsteking
- Hormonen
- Hormonen, hormoonvervangers en hormoonantagonisten
- Aminozuren, peptiden en eiwitten
- Aminozuren
- Aminozuren, aromatisch
- Aminozuren, cyclisch
- Schildklierhormonen
- Thyronines
- Thyroxine
- Triiodothyronine
Andere studie-ID-nummers
- PACS-2020-23242
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Informatie over medicijnen en apparaten, studiedocumenten
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Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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