危机预防研究 (CRISIS)
2013年4月16日 更新者:Michael Dean
危重病应激免疫抑制预防试验
尽管严格洗手、无菌技术和抗生素涂层导管,院内感染和败血症仍然是危重儿童发病率和死亡率的主要原因。
随后使用抗生素治疗院内感染和败血症被认为是该儿童人群中抗生素耐药生物体增加的主要归因因素。
本研究将使用双盲、随机、对照试验设计来检验每天使用甲氧氯普胺、锌、硒和谷氨酰胺进行预防会减少危重儿童的院内感染和败血症的假设。
研究概览
详细说明
尽管严格洗手、无菌技术和抗生素涂层导管,院内感染和败血症仍然是危重儿童发病率和死亡率的主要原因。
随后使用抗生素治疗院内感染和败血症被认为是该儿童人群中抗生素耐药生物体增加的主要归因因素。
目前,“预防”策略被用于预防压力引起的胃肠道出血;然而,没有使用“预防”策略来预防应激诱导的院内感染和败血症。
当没有受到对抗时,应激激素皮质醇会诱导淋巴细胞凋亡、淋巴细胞减少和免疫功能不全。
催乳素是一种反调节应激激素,可防止皮质醇诱导的细胞凋亡和免疫抑制。
锌、硒和谷氨酰胺在维持淋巴细胞健康方面也很重要。
重症患者通常继发于中枢神经系统多巴胺能活性增加以及利用增加和供应减少导致锌、硒和谷氨酰胺缺乏症继发低催乳素血症。
甲氧氯普胺是一种多巴胺 2 受体拮抗剂,通常用作儿童促运动剂,可预防低催乳素血症,肠内补充可预防锌、硒和谷氨酰胺缺乏症。
本研究将使用双盲随机对照试验设计来检验每天使用甲氧氯普胺、锌、硒和谷氨酰胺进行预防会减少危重儿童的院内感染和败血症的假设。
研究类型
介入性
注册 (实际的)
293
阶段
- 第三阶段
联系人和位置
本节提供了进行研究的人员的详细联系信息,以及有关进行该研究的地点的信息。
学习地点
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Arkansas
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Little Rock、Arkansas、美国、72202
- Arkansas Children's Hospital
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California
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Los Angeles、California、美国、90027
- Childrens Hospital of Los Angeles
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Los Angeles、California、美国、90095
- University of California Los Angeles Medical Center
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District of Columbia
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Washington、District of Columbia、美国、20010
- Children's National Medical Center
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Michigan
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Detroit、Michigan、美国、48201
- Children's Hospital of Michigan
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Pennsylvania
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Pittsburgh、Pennsylvania、美国、15213
- University of Pittsburgh Medical Center
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Washington
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Seattle、Washington、美国、98105
- Seattle Children's Hospital
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参与标准
研究人员寻找符合特定描述的人,称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
1年 至 17年 (孩子)
接受健康志愿者
不
有资格学习的性别
全部
描述
纳入标准:
在本研究的初始应计期间,在第一次中期分析之前,如果患者符合以下条件,则他们将有资格入组:
- 在 12 个月到 18 岁之间;和
- 在 PICU 入院后的前 48 小时内;和
- 有气管插管、中心静脉导管(新的或旧的、有隧道的或没有隧道的)或 Foley 导管;和
- 预计在研究登记的前三天内留置动脉或中心静脉导管进行血液采样。
在数据安全监测委员会 (DSMB) 进行第一次中期评估后,在招募了大约 200 名受试者后,DSMB 将就是否招募 40 周胎龄至 12 个月的受试者做出决定。 如果 DSMB 在第一次中期分析后批准婴儿入组,则符合以下条件的患者将有资格入组:
- 胎龄在 40 周到 18 岁之间;和
- 在 PICU 入院后的前 48 小时内;和
- 有气管插管、中心静脉导管(新的或旧的、有隧道的或没有隧道的)或 Foley 导管;和
- 预计在研究登记的前三天内留置动脉或中心静脉导管进行血液采样。
排除标准:
在本研究的初始应计期间,在第一次中期分析之前,如果以下任何一项为真或预期,患者将没有资格入组:
- 小于 1 岁;或者
- 大于或等于 18 岁;或者
- 已知对甲氧氯普胺过敏;或者
- 计划在研究登记后 72 小时内拔除气管插管、中心静脉导管和 Foley 导管,或
- 疑似肠梗阻,或
- 肠道手术或肠道破裂,或
- 入组前长期甲氧氯普胺治疗,或
- 未在 PICU 入院后 48 小时内登记,或
- 在过去 28 天内再次入住 PICU,或
- 之前参加过这项研究,或者
- 缺乏对积极的重症监护治疗的承诺。
在数据安全监测委员会 (DSMB) 进行第一次中期评估后,在招募了大约 200 名受试者后,DSMB 将就是否招募 40 周胎龄至 12 个月的受试者做出决定。 如果 DSMB 在第一次中期分析后批准婴儿入组,则如果以下任何一项为真或预期,则患者将没有资格入组:
- 小于 40 周胎龄;或者
- 大于或等于 18 岁;或者
- 已知对甲氧氯普胺过敏;或者
- 计划在研究登记后 72 小时内拔除气管插管、中心静脉导管和 Foley 导管,或
- 疑似肠梗阻
学习计划
本节提供研究计划的详细信息,包括研究的设计方式和研究的衡量标准。
研究是如何设计的?
设计细节
- 主要用途:预防
- 分配:随机化
- 介入模型:平行线
- 屏蔽:四人间
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:锌硒谷氨酰胺甲氧氯普胺
甲氧氯普胺、锌、硒和谷氨酰胺
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0.2 mg/kg/剂 IV 每 12 小时一次
其他名称:
每天一次肠内剂量的氯化锌(小于或等于一岁的婴儿每天 10 毫克元素锌,> 1 岁的患者每天 20 毫克元素锌)
每天一次肠内剂量的谷氨酰胺 0.3 gm/kg/天
每天一剂肠内硒(< 8 个月婴儿 40 微克,8 至 12 个月婴儿 60 微克,1-3 岁儿童 90 微克,4-8 岁儿童 150 微克,儿童 280 微克9 至 13 岁,> 13 岁的儿童为 400 微克)
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PLACEBO_COMPARATOR:肠内乳清蛋白和静脉注射盐水
生理盐水、无菌水、乳清蛋白
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等效体积的静脉内生理盐水
等量无菌水
等量无菌水
每天一剂肠内剂量的乳清蛋白
其他名称:
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研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
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本研究的主要终点是有气管插管、中心静脉导管或导尿管的 PICU 患者入住 PICU 与发生院内感染或临床败血症之间的中位时间。
大体时间:入院后 48 小时至出院后 5 天
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入院后 48 小时至出院后 5 天
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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每 100 个研究日的院内感染率或临床败血症率
大体时间:PICU 入院后 48 小时至 PICU 出院
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PICU 入院后 48 小时至 PICU 出院
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无抗生素日
大体时间:入院后 48 小时至 PICU 出院
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入院后 48 小时至 PICU 出院
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长期淋巴细胞减少症的发生率(绝对淋巴细胞计数小于或等于 1,000/mm³,持续 > 或等于 7 天)
大体时间:从 PICU 入院到从 PICU 出院
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报告的是计数符合淋巴细胞减少症的参与者人数。
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从 PICU 入院到从 PICU 出院
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全因 28 天死亡率。
大体时间:进入 PICU 后 28 天
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进入 PICU 后 28 天
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
赞助
合作者
调查人员
- 首席研究员:Joseph Carcillo, MD、University of Pittsburgh Medical Center
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
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研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查,以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始
2007年4月1日
初级完成 (实际的)
2009年11月1日
研究完成 (实际的)
2009年11月1日
研究注册日期
首次提交
2006年10月31日
首先提交符合 QC 标准的
2006年10月31日
首次发布 (估计)
2006年11月2日
研究记录更新
最后更新发布 (估计)
2013年4月18日
上次提交的符合 QC 标准的更新
2013年4月16日
最后验证
2013年4月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.