Efficacy and Safety of Remifentanil for Mechanically Ventilated Patients in ICU

NCT ID: NCT05003570

Last Updated: 2022-08-11

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

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

138 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-06-10

Study Completion Date

2022-12-30

Brief Summary

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Remifentanil has been approved by the FDA for continuation as an analgesic into the immediate postoperative period in adult patients under the direct supervision of an anesthesia practitioner in a postoperative anesthesia care unit or intensive care setting. However, National Medical Products Administration(NMPA) did not approve this indication. Therefore, the purpose of this study is to confirm the efficacy and safety of remifentanil in the analgesic therapy of critical ill patients in China.

Detailed Description

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The study was conducted in accordance with good clinical practice and with the guidelines set out in the Declaration of Helsinki. After approval from local and national ethics committees, patients from 17 centres in China were recruited. All patients were randomized, in a double-blind manner, to receive either a remifentanil-propofol regimen or a fentanyl-propofol regimen for analgesia and sedation in the ICU. The aim of the study was to achieve optimal sedation and patient comfort by maintaining an optimal Critical Care Pain Observation Tool (CPOT) score of 2, without clinically significant pain, until the start of the extubation process or for 72 hours, whichever occurred first. CPOT scoring criteria: Facial expressions(Relaxed, neutral=0; Tense=1; Grimacing=2); Body movements(Absence of movements or normal position=0; Protection=1; Restlessness/Agitation=2); Muscle tension(Relaxed=0; Tense, rigid=1; Very tense or rigid=2); Compliance with the ventilator or Vocalization(Tolerating ventilator or movement/Talking in normal tone or no sound=0; Coughing but tolerating/Sighing, moaning=1; Fighting ventilator/Crying out, sobbing=2).

Conditions

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Analgesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Remifentanil

Remifentanil analgesia combined with propofol sedation. Treatment was started in patients with an CPOT score of 2 or greater after completion of baseline assessments. All patients received an initial infusion of blinded opioid (placebo bolus dose(6ml) + 6ug/kg per hour infusion at 6 ml/hour). Optimal analgesia (CPOT score ≤2) was then targeted by titrating the infusion in 1.5 ml/hour increments (placebo bolus dose + 1.5ug/kg per hour rate increase).

Group Type EXPERIMENTAL

Remifentanil

Intervention Type DRUG

Dosage forms and strengths: 3 mL Vial/1 mg lyophilized powder. Manufacturer: Yichang Humanwell Pharmaceutical Co.,Ltd

Fentanyl

Fentanyl analgesia combined with propofol sedation. Treatment was started in patients with an CPOT score of 2 or greater after completion of baseline assessments. All patients received an initial infusion of blinded opioid (1ug/kg bolus(6ml) + 1ug/kg per hour infusion at 6ml/hour). Optimal analgesia (CPOT score ≤2) was then targeted by titrating the infusion in 1.5 ml/hour increments (1ug/kg bolus dose + 0.25ug/kg per hour rate increase).

Group Type ACTIVE_COMPARATOR

Fentanyl

Intervention Type DRUG

Dosage forms and strengths: 50 mcg/mL Fentanyl base/10 mL ampules. Manufacturer: Yichang Humanwell Pharmaceutical Co.,Ltd

Interventions

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Remifentanil

Dosage forms and strengths: 3 mL Vial/1 mg lyophilized powder. Manufacturer: Yichang Humanwell Pharmaceutical Co.,Ltd

Intervention Type DRUG

Fentanyl

Dosage forms and strengths: 50 mcg/mL Fentanyl base/10 mL ampules. Manufacturer: Yichang Humanwell Pharmaceutical Co.,Ltd

Intervention Type DRUG

Other Intervention Names

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Remifentanil Hydrochloride for Injection Fentanyl Citrate Injection

Eligibility Criteria

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Inclusion Criteria

* Invasive mechanical ventilation with endotracheal intubation
* Expected to continue mechanical ventilation for more than 12 hours
* Informed consent/assent was obtained from all patients or their representatives

Exclusion Criteria

* Patients with a history of allergy to opioids, benzodiazepines, propofol, or alcohol/drug abuse were excluded from the study
* Patients who are known or suspected to be allergic to the study drug
* Patients whose expected survival time is less than 48h
* Patients receiving deep sedation (RASS≥-4)
* Patients using neuromuscular blocking agent
* Patients who cannot be assessed by RASS
* Patients with myasthenia gravis
* patients with bronchial asthma
* patients with abdominal compartment syndrome
* Patients who need surgery or tracheotomy during the study drug treatment period
* Women during pregnancy and lactation
* Patients who have used short-acting non-steroidal anti-inflammatory drugs within 6 hours
* Patients who have used long-acting non-steroidal anti-inflammatory drugs within 12 hours
* Patients with a history of chronic pain for more than 3 months or who are receiving regular analgesia for more than 3 months
* Patients who have used monoamine oxidase inhibitors within two weeks
* Patients who participate in any clinical trials as subjects within 1 month
* Patients with a history of drug abuse, drug abuse, alcohol abuse\* and long-term use of psychotropic drugs within 2 years Alcoholism: Drinking more than 14 times/week (1 time=150ml wine or 360ml beer or 45ml spirits)
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Southeast University, China

OTHER

Sponsor Role lead

Responsible Party

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Ling Liu

professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Yang Yi, MD

Role: STUDY_CHAIR

Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University

Locations

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Anhui Provincial Hospital

Hefei, Anhui, China

Site Status RECRUITING

Beijing Tiantan Hospital, Capital Medical University

Beijing, Beijing Municipality, China

Site Status RECRUITING

The First Affiliated Hospital of Chongqing Medical University

Chongqing, Chongqing Municipality, China

Site Status RECRUITING

Qingyuan People's Hospital

Qingyuan, Guangdong, China

Site Status RECRUITING

Affiliated Hospital of Guizhou Medical University

Guiyang, Guizhou, China

Site Status RECRUITING

Affiliated Hospital of Zunyi Medical University

Zunyi, Guizhou, China

Site Status RECRUITING

The Fourth Hospital of Hebei Medical University

Shijiazhuang, Hebei, China

Site Status RECRUITING

First Affiliated Hospital of Zhengzhou University

Zhengzhou, Henan, China

Site Status RECRUITING

Henan Provincial People's Hospital

Zhengzhou, Henan, China

Site Status RECRUITING

Enshi Tujia and Miao Autonomous Prefecture Central Hospital

Enshi, Hubei, China

Site Status RECRUITING

Yichang Central People's Hospital

Yichang, Hubei, China

Site Status RECRUITING

The Third Xiangya Hospital of Central South University

Changsha, Hunan, China

Site Status RECRUITING

Xiangya Hospital of Central South University

Changsha, Hunan, China

Site Status RECRUITING

Nanjing Zhong-Da Hospital, Southeast University

Nanjing, Jiangsu, China

Site Status RECRUITING

Northern Jiangsu People's Hospital

Yangzhou, Jiangsu, China

Site Status RECRUITING

Zhejiang Provincial People's Hospital

Hangzhou, Zhejiang, China

Site Status RECRUITING

The First Affiliated Hospital of Wenzhou Medical University

Wenzhou, Zhejiang, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Yang Yi, MD

Role: CONTACT

+86-25-83262552

Liu Ling, MD

Role: CONTACT

13851435472

Facility Contacts

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Pan Aijun, MD

Role: primary

+8613866668786

Zhou Jianxin, MD

Role: primary

+8613801183875

Zhou Fachun, MD

Role: primary

+8618502388799

Yang Jingwen, MD

Role: primary

+8613542498765

Shen Feng, MD

Role: primary

+8613511999117

Chen Tao, MD

Role: primary

+8615329112288

Hu Zhenjie, MD

Role: primary

+8613933856908

Sun Tongwen, MD

Role: primary

+8613838516916

Qin Bingyu, MD

Role: primary

+8613633810677

Li Dezhong, MD

Role: primary

+8615342885588

Gong Xun, MD

Role: primary

+8615872549520

Yang Mingshi, MD

Role: primary

+8613973139006

Zhang Lina, MD

Role: primary

+8615874875763

Ling Liu, pHd

Role: primary

+86-25-83262550

Yang Yi, pHd

Role: backup

+86-25-83262552

Zheng Rui qiang, MD

Role: primary

+8613952721411

Sun Renhua, MD

Role: primary

+8613505710366

Pan Jingye, MD

Role: primary

+8613566289666

Other Identifiers

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ZDRF

Identifier Type: -

Identifier Source: org_study_id

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