Comparison of an Inhaled Sedation Strategy to an Intravenous Sedation Strategy in Intensive Care Unit Patients Treated With Invasive Mechanical Ventilation

NCT ID: NCT04341350

Last Updated: 2025-04-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-06

Study Completion Date

2026-08-31

Brief Summary

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The objective of the study is to determine the impact on the frequency of occurrence of delirium of an early inhaled sedation strategy (from induction in rapid sequence if intubation in intensive care, or from admission if intubated in pre -hospital) by Isoflurane using an ANACONDA ™ type system, compared to a conventional intravenous sedation strategy.

Detailed Description

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Sedation-analgesia is used in most patients treated with mechanical ventilation (MV). The usual benzodiazepine and morphine sedation reduces pain and anxiety and allows tolerance of invasive procedures in intensive care. These molecules, used as part of the sedation titration protocol or the daily sedation stop protocol, have improved patient outcomes.

Although necessary, these drugs, by mechanisms still uncertain, would promote the occurrence of resuscitation delirium. Delirium itself responsible for worsening morbidity and mortality (increase in the duration of MV, increase in the length of hospital stay, discussed increase in mortality, long-term cognitive sequelae).

This finding favored the use of new drugs in the sedation strategies of patients on MV. Dexmedetomidine has for example reduced the number of days of delirium, the number of days of coma and even mortality in septic patients. Its large-scale use has however been questioned by a recent study.

Halogenated gases have been used for a long time in anesthesia. Their pharmacodynamics, their positive and adverse effects, their therapeutic margins are well known. Thanks to technical innovations they can be used on resuscitation respirators. Several studies on targeted populations have shown the feasibility and the benefits of this use, in particular, the absence of accumulation, the absence of tachyphylaxis, the broad therapeutic range, the small interindividual variation, the rapidity of efficacy and the speed of awakening. Safety in use for the staff in charge of the patient is established. In addition, their potential neuroprotective effect would make it an anesthetic of choice in the prevention of resuscitation delirium.

Conditions

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Prevention of Delirium

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Usual sedation

Sedation according to a written, standardized Nurse management protocol using at least one sedative drug (propofol) and one analgesic drug.

Group Type ACTIVE_COMPARATOR

Propofol + analgesic drug

Intervention Type DRUG

sedation according to a written, standardized Nurse management protocol using at least one sedative drug (propofol) and one analgesic drug. It uses the nurse driven analgesia protocol of each ward involved in the study. It uses a pain assessment score (BPS, VICOMORE, FLACC), local or regional anesthesia, non-opioïd adjuncts (acetaminophen, NSAIDs, nefopam), opioïds (per os opioïds, bolus of sufentanyl followed by continuous infusion if necessary, continuous infusion of remifentanyl

Inhaled sedation

Sedation by inhalation of halogenated gas (Isoflurane) delivered by the Anesthetic-Conserving Device (ACD) system ANACONDA ™ associated with the administration of an analgesic drug.

Group Type EXPERIMENTAL

Isoflurane + analgesic drug

Intervention Type DRUG

sedation by inhalation of halogenated gas (Isoflurane) delivered by the Anesthetic-Conserving Device (ACD) system ANACONDA ™ associated with the administration of a analgesic drug. It uses the nurse driven analgesia protocol of each ward involved in the study. It uses a pain assessment score (BPS, VICOMORE, FLACC), local or regional anesthesia, non-opioïd adjuncts (acetaminophen, NSAIDs, nefopam), opioïds (per os opioïds, bolus of sufentanyl followed by continuous infusion if necessary, continuous infusion of remifentanyl.

Interventions

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Propofol + analgesic drug

sedation according to a written, standardized Nurse management protocol using at least one sedative drug (propofol) and one analgesic drug. It uses the nurse driven analgesia protocol of each ward involved in the study. It uses a pain assessment score (BPS, VICOMORE, FLACC), local or regional anesthesia, non-opioïd adjuncts (acetaminophen, NSAIDs, nefopam), opioïds (per os opioïds, bolus of sufentanyl followed by continuous infusion if necessary, continuous infusion of remifentanyl

Intervention Type DRUG

Isoflurane + analgesic drug

sedation by inhalation of halogenated gas (Isoflurane) delivered by the Anesthetic-Conserving Device (ACD) system ANACONDA ™ associated with the administration of a analgesic drug. It uses the nurse driven analgesia protocol of each ward involved in the study. It uses a pain assessment score (BPS, VICOMORE, FLACC), local or regional anesthesia, non-opioïd adjuncts (acetaminophen, NSAIDs, nefopam), opioïds (per os opioïds, bolus of sufentanyl followed by continuous infusion if necessary, continuous infusion of remifentanyl.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patient aged 18 and over
* Patient requiring mechanical ventilation for at least 24 hours
* The patient requires continuous and immediate sedation for more comfort, safety and to facilitate the administration of survival measures.
* Consent obtained from patient or relative

Exclusion Criteria

Patient hospitalized for the following reasons for admission:

* Cardiac arrest
* State of refractory epilepticus
* Head trauma
* Stroke

* Hearing, visual or aphasia disorders before inclusion making it impossible to take the CAM-ICU
* Sedation started more than 24 hours ago
* Impairment of cognitive functions and / or dementia
* Contraindication to halogenated gases (personal or family history of malignant hyperthermia, acute or chronic neuromuscular disease, hepatocellular insufficiency with PT \<30%)
* Severe acute respiratory distress syndrome (ARDS) (Berlin criteria: PaO2 / FiO2 \<100 after ventilatory optimisation))
* PaCO2 at inclusion\> 50 mmHg after ventilatory optimisation
* Patient for whom a procedure of "limitation of active therapies" is envisaged at inclusion
* Patient under guardianship or curatorship
* Minor patient
* Pregnant or breastfeeding woman
* Patient not affiliated to the social security scheme
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Brest

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Pierre Bailly, MD

Role: PRINCIPAL_INVESTIGATOR

CHRU Brest

Locations

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CH Bourges

Bourges, , France

Site Status RECRUITING

CHU de Brest

Brest, , France

Site Status RECRUITING

CH Corbeil Essonnes

Corbeil-Essonnes, , France

Site Status RECRUITING

CH Le Mans

Le Mans, , France

Site Status RECRUITING

GHBS Lorient

Lorient, , France

Site Status RECRUITING

CH Melun

Melun, , France

Site Status RECRUITING

CHU Montpellier

Montpellier, , France

Site Status SUSPENDED

CH Morlaix

Morlaix, , France

Site Status RECRUITING

CHU Poitiers

Poitiers, , France

Site Status RECRUITING

CHU Rennes

Rennes, , France

Site Status RECRUITING

CHU Tours - Réanimation Chirurgicale

Tours, , France

Site Status NOT_YET_RECRUITING

CHU Tours

Tours, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Pierre Bailly, MD

Role: CONTACT

02 98 34 71 81 ext. +33

Facility Contacts

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Anna BOURREAU, Dr

Role: primary

02 48 48 48 48 ext. +33

Pierre Bailly, MD

Role: primary

02 98 34 71 81 ext. +33

Billiou Cecilia, MD

Role: primary

0161693519

Christophe GUITTON, Dr

Role: primary

02 53 04 04 42 ext. +33

Guillaume GRILLET, Dr

Role: primary

Sandie MAZERAND, MD

Role: primary

0181742641 ext. +33

Pierre-Yves EGRETEAU, Dr

Role: primary

02 98 62 60 95 ext. +33

Arnaud THILLE, Pr

Role: primary

05 49 44 43 67 ext. +33

Florian REIZINE, Dr

Role: primary

Mathilde BARBAZ

Role: primary

07.62.12.70.34

Role: backup

Stephan EHRMANN, Pr

Role: primary

06 71 10 33 02 ext. +33

References

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Bailly P, Egreteau PY, Ehrmann S, Thille AW, Guitton C, Grillet G, Reizine F, Huet O, Jaber S, Nowak E, L'her E. Inased (inhaled sedation in ICU) trial protocol: a multicentre randomised open-label trial. BMJ Open. 2021 Feb 19;11(2):e042284. doi: 10.1136/bmjopen-2020-042284.

Reference Type DERIVED
PMID: 33608400 (View on PubMed)

Other Identifiers

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INASED (29BRC19.0280)

Identifier Type: -

Identifier Source: org_study_id

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