Daily Sedative Interruption in Critically Ill Patients Being Managed With a Sedation Protocol

NCT ID: NCT00298493

Last Updated: 2006-03-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 65 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2001-02-28
• Study Completion Date: 2004-09-30

Brief Summary

All critically ill, mechanically ventilated patients in the Intensive Care Unit receive medications to relieve pain and anxiety. However, accumulation of these medications can be associated with serious complications, most notably longer time on the breathing machine and in the ICU. Two strategies have been shown to dramatically improve patient outcomes: nurse-directed protocols for giving sedation, and daily interruption of sedation. However, these strategies have not been widely adopted, because of physicians' concerns, and because it is unclear which strategy is better. Given that patient outcome is improved with either of these strategies, the fundamental question that arises is whether patients managed with a combination of two strategies which both reduce drug accumulation (protocolized sedation and daily interruption) have an even better outcome than patients managed with only one of them (protocolized sedation). We propose a multicenter study in which 700 critically ill, mechanically ventilated patients will have their sedation managed with protocolized sedation alone, or both strategies. Both groups of patients will have the following recorded: ICU and hospital lengths of stay, mortality, total sedative drug use, ICU human resources used, side effects and recall of their ICU stay. The results of this large multi-center trial will help to inform best practice with regard to sedation management of critically ill patients in Canada and elsewhere. In addition, reducing ICU stay could be economically attractive, as the cost of an ICU day in Canada is approximately $3000.

Conditions

Critical Illness; Mechanical Ventilation

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Interventions

Sedation management strategy

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

1. age>18 years

2. Mechanically ventilated, with anticipated need for MV ≥ 48 hours

3. ICU team has decided to initiate continuous sedative/analgesic infusion(s)

4. informed consent.

Exclusion Criteria

1. Admission after resuscitation from cardiac arrest

2. Traumatic brain injury

3. Currently receiving neuromuscular blocking agents

4. Allergy to any of the study medications

5. History of alcohol, sedative or analgesic abuse

6. History of psychiatric illness

7. Acute or chronic neurologic dysfunction

8. Administration of sedatives for >24 hr,

9. Lack of commitment to aggressive treatment

10. Current enrollment in a related trial

11. Previous enrollment in this trial.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

The Physicians' Services Incorporated Foundation

OTHER

Sponsor Role: collaborator

Mount Sinai Hospital, Canada

OTHER

Sponsor Role: lead

Principal Investigators

Sangeeta Mehta, MD

Role: PRINCIPAL_INVESTIGATOR

MOUNT SINAI HOSPITAL

Locations

Mount Sinai Hospital

Toronto, Ontario, Canada

Countries

Canada

References

Mehta S, Burry L, Martinez-Motta JC, Stewart TE, Hallett D, McDonald E, Clarke F, Macdonald R, Granton J, Matte A, Wong C, Suri A, Cook DJ; Canadian Critical Care Trials Group. A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial. Crit Care Med. 2008 Jul;36(7):2092-9. doi: 10.1097/CCM.0b013e31817bff85.

Reference Type: DERIVED

PMID: 18552687 (View on PubMed)

Other Identifiers

MSH REB#00-0032-A

Identifier Type: -

Identifier Source: org_study_id