Effect of Bispectral Index (BIS) Titrated Propofol Sedation on Lower Esophageal Sphincter Pressures and Esophageal Function in Intensive Care Patients
2014年3月4日 更新者：Alparslan Turan、The Cleveland Clinic
Effect of BIS Titrated Propofol Sedation on Lower Esophageal Sphincter Pressures and Esophageal Function in Intensive Care Patients
Eligible patients will be allocated to receive propofol sedation titrated to 3 different Bispectral Index (BIS) levels in a random order.
Primary hypothesis: Deepening propofol sedation - as determined by BIS - lowers esophageal pressure in critical care patients.
研究概览
详细说明
Patient will be selected from the ICU, based on the defined inclusion and exclusion criteria. Potential study subjects will be screened by the research fellow or the on-site study co-investigator. Eligible patients will be allocated to receive propofol sedation titrated to 3 different BIS levels in a random order. BIS XP monitors (Aspect Medical Systems, Norwood, MA, USA) will be used which are relatively resistant to EMG artifact; a BIS sensor will be position on forehead of the patient after the skin is degreased and gently abraded. Esophageal pressure monitoring will be performed by a catheter inserted from the nose to the esophagus and left there trough the study period.
If patients are on sedation they will be placed on propofol sedation for a washout period. Each patient will receive propofol sedation by continuous infusion titrated to a different levels of BIS in a randomized fashion according to a computer-generated random-number sequence;
- BIS levels of 70, will be targeted (Anxiolysis/high-frequency EEG activity, beta-augmentation);
- BIS levels of 50 will be targeted, (Low frequency EEG activity, theta-delta activity);
- BIS levels of 35 will be targeted (low frequency EEG activity). A propofol infusion will be titrated by the investigators to the designated BIS target according to randomization. Clinical personnel will not be blinded to the study, and if patient has clinically significant change in hemodynamic parameters study will be interrupted. Each BIS target level will be kept as constant as possible for at least one hour; thereafter, lower esophageal pressures will be recorded for 15 minutes using high resolution esophageal manometry. Studies will be done in supine position [Most ICU patients are now kept head-up.], and the manometric assembly will be positioned to record from the hypopharynx to the stomach with 4-6 of the sensors positioned in the stomach.
All patients will otherwise receive routine ICU care and medications without interruption of standard clinical care.
研究类型
介入性
注册 (实际的)
1
阶段
- 不适用
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
-
-
Ohio
-
Cleveland、Ohio、美国、44195
- Cleveland Clinic
-
-
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
18年 至 80年 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
Inclusion Criteria:
- 18-80 years of age
- Written informed consent from relatives
- Clinically stable
- Mechanically ventilated < 2days
- Require sedation and expected to be given propofol
Exclusion Criteria:
- Recent injury or other pathologic condition of the esophagus
- Major bronchopleural fistula
- History of liver failure
- History of renal failure
- History of major neuromuscular disease
- Multiple trauma
- Upper motor nerve injury
- Hypersensitivity to propofol
- Recent gastrointestinal surgery
- Patients with a diagnosed or suspected condition that may give false results in BIS monitoring.
- Tracheostomized patients
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：并行分配
- 屏蔽：双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
有源比较器：BIS 70
BIS levels of 70, will be targeted (Anxiolysis/high-frequency EEG activity, beta-augmentation);
|
Each patient will receive propofol sedation by continuous infusion titrated to a BIS level of 70.
其他名称：
|
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有源比较器：BIS 50
BIS levels of 50 will be targeted, (Low frequency EEG activity, theta-delta activity)
|
Each patient will receive propofol sedation by continuous infusion titrated to a BIS level of 50.
其他名称：
|
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有源比较器：BIS 35
BIS levels of 35 will be targeted (low frequency EEG activity)
|
Each patient will receive propofol sedation by continuous infusion titrated to a BIS level of 35.
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 |
措施说明 |
大体时间 |
|---|---|---|
|
Deepening propofol sedation - as determined by BIS - lowers esophageal pressure in critical care patients.
大体时间：for 15 minutes after assigned BIS level has been maintained for one hour, while in the ICU
|
Sedation will also be evaluated with the bispectral index of the electroencephalogram. BIS of the EEG data will be acquired with 4 BIS-sensor electrodes and a BIS XP monitor.
The BIS will be recorded electronically at one-minute intervals.
Heart rate, blood pressures (diastolic and systolic), respiratory rate, core temperature and oxygen saturation will be recorded every 5 minutes during the measurement period of the study.
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for 15 minutes after assigned BIS level has been maintained for one hour, while in the ICU
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Deepening propofol sedation - as measured by Sedation Agitation Scale, Richmond Agitation Scale Score, and Ramsay sedation scale - lowers esophageal pressure in critical care patients.
大体时间：every 10 minutes, while sedated in the ICU
|
The SAS uses a 1 to 7 point scale to make a determination of the patient's level of agitation and sedation from a rating of 7 dangerously agitated to a rating of 1 unarousable (Table 1).
Clinical sedation assessments using SAS and RASS scales will be measured every 10 minutes through the study period.
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every 10 minutes, while sedated in the ICU
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Modifying the target level of BIS titration affects upper esophageal pressures and esophageal peristalsis.
大体时间：for 15 minutes after assigned BIS level has been maintained for one hour, while in the ICU
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Upper esophageal sphincter pressures, transient LES relaxations, and regurgitations will be evaluated by the GI team from recorded data from high resolution manometry.
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for 15 minutes after assigned BIS level has been maintained for one hour, while in the ICU
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There is an association between ventilator associated pneumonia and baseline lower esophageal and barrier pressure.
大体时间：daily, until hospital discharge
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Patients will be followed for their stay in the hospital for occurrence of ventilator associated pneumonia.
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daily, until hospital discharge
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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。
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
2010年7月1日
初级完成 (实际的)
2011年3月1日
研究完成 (实际的)
2011年3月1日
研究注册日期
首次提交
2010年7月21日
首先提交符合 QC 标准的
2010年7月30日
首次发布 (估计)
2010年8月2日
研究记录更新
最后更新发布 (估计)
2014年3月5日
上次提交的符合 QC 标准的更新
2014年3月4日
最后验证
2014年3月1日
更多信息
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