Immunozapalna regulacja esketaminy u pacjentów z posocznicą
Wpływ esketaminy w połączeniu z propofolem do sedacji na ogólnoustrojowe zapalenie i funkcje odpornościowe u pacjentów z sepsą na OIT: jednoośrodkowe, nieślepe, prospektywne randomizowane badanie kontrolowane
Studies have shown that excessive systemic inflammatory response and concomitant immunosuppression are the main cause of early death in patients with sepsis. Therefore, it is very important to reduce excessive inflammation and improve immunosuppression in the acute phase of sepsis. Clinical studies have shown that esketamine combined with propofol for sedation has been proven to be safe and effective for septic patients in the ICU due to its cardiovascular stability. Previous studies have demonstrated that esketamine has anti-inflammatory effects against depression and surgical stress. Our preliminary experimental studies have found that esketamine had strong anti-inflammatory effects in the acute phase of sepsis. However, it is not clear whether esketamine could reduce excessive inflammation and improve immunosuppression in septic patients primarily sedated with a continuous infusion of propofol.
This intervention study is to investigate whether three consecutive days of intravenous esketamine infusions via infusion pump (0.07 mg/kg/h) could reduce excessive inflammation and improve immunosuppression in septic patients requiring mechanical ventilation in the ICU under sedation primarily with propofol.
Przegląd badań
Status
Interwencja / Leczenie
Typ studiów
Zapisy (Rzeczywisty)
Faza
- Faza 4
Kontakty i lokalizacje
Lokalizacje studiów
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Hubei
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Wuhan, Hubei, Chiny, 430022
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
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Kryteria uczestnictwa
Kryteria kwalifikacji
Wiek uprawniający do nauki
Akceptuje zdrowych ochotników
Płeć kwalifikująca się do nauki
Opis
Inclusion Criteria:
- 18 years old ≤ age ≤60 years old;
- SOFA score ≥2;
- Mechanical ventilation should be required for at least 24 hours when included in the study;
- Informed consent is obtained.
Exclusion Criteria:
- Age < 18 years old or ≥ 60 years old;
- Previous solid organ or bone marrow transplantation;
- Autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, etc.), or hematologic malignancies (leukemia and lymphoma, etc.);
- Received radiotherapy or chemotherapy within the past 30 days, or received immunosuppressant drugs (tripterygium wilfordii, mycophenolate mofetil, cyclophosphamide, FK506, etc.), or continuous treatment with prednisolone more than 10 mg/day (or equivalent doses of the other hormones);
- Unstable angina pectoris or myocardial infarction in the past six months;
- Acute brain injury (traumatic brain injury, subarachnoid hemorrhage, acute ischemic stroke, acute intracranial hemorrhage, acute intracranial infection, etc.);
- Poorly controlled hypertension and congestive heart failure;
- Increased intraocular or intracranial pressure;
- Chronic kidney disease, received continuous renal replacement therapy in the past 30 days, or acute renal failure requiring CRRT;
- Severe chronic liver disease (Child-Pugh class B or C);
- Alcohol dependence, mental illness or severe cognitive impairment;
- Pregnancy or lactation;
- Informed consent is not obtained.
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Leczenie
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Pojedynczy
Broń i interwencje
Grupa uczestników / Arm |
Interwencja / Leczenie |
|---|---|
|
Eksperymentalny: esketamine plus propofol
After inclusion, patients are sedated primarily with propofol (0-3 mg/kg/h) using a microinfusion pump and adjusted according to the depth of sedation (Richmond Agitation Sedation Scale (RASS): 0 to -2). After inclusion, septic patients will be received a single intravenous injection of esketamine (0.7 mg/kg), and then followed by an intravenous administration of esketamine (0.07 mg/kg/h) with an infusion pump for three consecutive days. |
After inclusion, septic patients will be received a single intravenous injection of esketamine (0.7 mg/kg), and then followed by an intravenous administration of esketamine (0.07 mg/kg/h) with an infusion pump for three consecutive days. |
|
Brak interwencji: propofol
After inclusion, patients are sedated primarily with propofol (0-3 mg/kg/h) using a microinfusion pump and adjusted according to the depth of sedation (Richmond Agitation Sedation Scale (RASS): 0 to -2). |
Co mierzy badanie?
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
|
Serum concentration of inflammatory cytokines (0 h)
Ramy czasowe: 0 hour after study inclusion
|
Interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-2, IL-4, IL-10, IL-17A, and interferon (IFN)-γ |
0 hour after study inclusion
|
|
Serum concentration of inflammatory cytokines (48 h)
Ramy czasowe: 48 hours after study inclusion
|
IL-6, TNF-α, IL-2, IL-4, IL-10, IL-17A, and IFN-γ |
48 hours after study inclusion
|
|
Serum concentration of inflammatory cytokines (72 h)
Ramy czasowe: 72 hours after study inclusion
|
IL-6, TNF-α, IL-2, IL-4, IL-10, IL-17A, and IFN-γ |
72 hours after study inclusion
|
|
Absolute number of lymphocyte subsets in the peripheral blood (0 h)
Ramy czasowe: 0 hour after study inclusion
|
CD3(+), CD3(+) CD4(+), CD3(+) CD8(+), CD3(-) CD16(+) CD56(+) , and CD19(+) cells |
0 hour after study inclusion
|
|
Absolute number of lymphocyte subsets in the peripheral blood (48 h)
Ramy czasowe: 48 hours after study inclusion
|
CD3(+), CD3(+) CD4(+), CD3(+) CD8(+), CD3(-) CD16(+) CD56(+) , and CD19(+) cells |
48 hours after study inclusion
|
|
Absolute number of lymphocyte subsets in the peripheral blood (72 h)
Ramy czasowe: 72 hours after study inclusion
|
CD3(+), CD3(+) CD4(+), CD3(+) CD8(+), CD3(-) CD16(+) CD56(+) , and CD19(+) cells |
72 hours after study inclusion
|
|
ICU length of stay
Ramy czasowe: up to 8 weeks
|
Length of stay in the ICU |
up to 8 weeks
|
Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
|
Serum concentration of atrial natriuretic peptide (ANP) (0 h)
Ramy czasowe: 0 hour after study inclusion
|
ANP is secreted primarily by atrial cardiomyocytes |
0 hour after study inclusion
|
|
Serum concentration of atrial natriuretic peptide (ANP) (48h)
Ramy czasowe: 48 hours after study inclusion
|
ANP is secreted primarily by atrial cardiomyocytes |
48 hours after study inclusion
|
|
Serum concentration of atrial natriuretic peptide (ANP) (72h)
Ramy czasowe: 72 hours after study inclusion
|
ANP is secreted primarily by atrial cardiomyocytes |
72 hours after study inclusion
|
|
Acute physiology and chronic health evaluation (APACHE) Ⅱ score
Ramy czasowe: 0 hour after study inclusion
|
0-67, higher scores correspond to more severe disease and a higher risk of death |
0 hour after study inclusion
|
|
Acute physiology and chronic health evaluation (APACHE) Ⅱ score
Ramy czasowe: 24 hours after study inclusion
|
0-67, higher scores correspond to more severe disease and a higher risk of death |
24 hours after study inclusion
|
|
Acute physiology and chronic health evaluation (APACHE) Ⅱ score
Ramy czasowe: 48 hours after study inclusion
|
0-67, higher scores correspond to more severe disease and a higher risk of death |
48 hours after study inclusion
|
|
Acute physiology and chronic health evaluation (APACHE) Ⅱ score
Ramy czasowe: 72 hours after study inclusion
|
0-67, higher scores correspond to more severe disease and a higher risk of death |
72 hours after study inclusion
|
|
Sequential organ failure assessment (SOFA) score
Ramy czasowe: 0 hour after study inclusion
|
0-43, higher scores correspond to more severe sepsis |
0 hour after study inclusion
|
|
Sequential organ failure assessment (SOFA) score
Ramy czasowe: 24 hours after study inclusion
|
0-43, higher scores correspond to more severe sepsis |
24 hours after study inclusion
|
|
Sequential organ failure assessment (SOFA) score
Ramy czasowe: 48 hours after study inclusion
|
0-43, higher scores correspond to more severe sepsis |
48 hours after study inclusion
|
|
Sequential organ failure assessment (SOFA) score
Ramy czasowe: 72 hours after study inclusion
|
0-43, higher scores correspond to more severe sepsis |
72 hours after study inclusion
|
|
Mechanical ventilation time after inclusion
Ramy czasowe: Up to 8 weeks
|
Patients requiring mechanical ventilation after study inclusion |
Up to 8 weeks
|
|
Total hospital length of stay
Ramy czasowe: Through study completion, an average of 2 year
|
Total length of hospital stay |
Through study completion, an average of 2 year
|
|
Infection complications
Ramy czasowe: Through study completion, an average of 2 year
|
Pulmonary infection, urinary tract infection, bloodstream infections, etc |
Through study completion, an average of 2 year
|
|
In-hospital mortality
Ramy czasowe: Through study completion, an average of 2 year
|
Mortality rates for the entire period of hospitalization |
Through study completion, an average of 2 year
|
|
90-day readmission rate
Ramy czasowe: Through study completion, an average of 2 year
|
Percentage of readmission to hospital within 90 days of study inclusion |
Through study completion, an average of 2 year
|
|
CCL1 expression in alveolar macrophages (0 h)
Ramy czasowe: 0 hour after study inclusion
|
CCL1 expression in alveolar macrophages collected from bronchoalveolar lavage fluid |
0 hour after study inclusion
|
|
CCL1 expression in alveolar macrophages (24 h)
Ramy czasowe: 24 hours after study inclusion
|
CCL1 expression in alveolar macrophages collected from bronchoalveolar lavage fluid |
24 hours after study inclusion
|
|
CCL1 expression in alveolar macrophages (72 h)
Ramy czasowe: 72 hours after study inclusion
|
CCL1 expression in alveolar macrophages collected from bronchoalveolar lavage fluid |
72 hours after study inclusion
|
|
expression of WNT pathway proteins in alveolar macrophages (0 h)
Ramy czasowe: 0 hour after study inclusion
|
Wnt5a, FZD5, b-catenin, Lef1 expression in alveolar macrophages collected from bronchoalveolar lavage fluid |
0 hour after study inclusion
|
|
expression of WNT pathway proteins in alveolar macrophages (24 h)
Ramy czasowe: 24 hours after study inclusion
|
Wnt5a, FZD5, b-catenin, Lef1 expression in alveolar macrophages collected from bronchoalveolar lavage fluid |
24 hours after study inclusion
|
|
expression of WNT pathway proteins in alveolar macrophages (72 h)
Ramy czasowe: 72 hours after study inclusion
|
Wnt5a, FZD5, b-catenin, Lef1 expression in alveolar macrophages collected from bronchoalveolar lavage fluid |
72 hours after study inclusion
|
Współpracownicy i badacze
Śledczy
- Główny śledczy: Shiying Yuan, PhD, MD, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
Daty zapisu na studia
Główne daty studiów
Rozpoczęcie studiów (Rzeczywisty)
Zakończenie podstawowe (Rzeczywisty)
Ukończenie studiów (Rzeczywisty)
Daty rejestracji na studia
Pierwszy przesłany
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy wysłany (Rzeczywisty)
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia weryfikacja
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
Inne numery identyfikacyjne badania
- YSY202001
Plan dla danych uczestnika indywidualnego (IPD)
Planujesz udostępniać dane poszczególnych uczestników (IPD)?
Opis planu IPD
After the completion of the study, the original data will be sent to the email address: zhjcheng1@163.com, and the password will be provided after the paper is published.
Ramy czasowe udostępniania IPD
Six months after the paper was published
Kryteria dostępu do udostępniania IPD
The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.
Typ informacji pomocniczych dotyczących udostępniania IPD
- CSR
Informacje o lekach i urządzeniach, dokumenty badawcze
Bada produkt leczniczy regulowany przez amerykańską FDA
Bada produkt urządzenia regulowany przez amerykańską FDA
produkt wyprodukowany i wyeksportowany z USA
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