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
Total Enrollment
60 participants
Study Classification
OBSERVATIONAL
Study Start Date
2024-01-12
Study Completion Date
2025-08-06
Brief Summary
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The purpose of this study is to determine whether additional investigations used in other parts of healthcare can be used in the Emergency Department to identify critically ill patients quicker than usual care.
Detailed Description
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The investigators intend to recruit 56 patients with suspected sepsis who attend the Emergency Department. The investigators want to use a device to monitor tissue oxygen levels when they first come into the Emergency Department as well as the change in tissue oxygen levels when a tourniquet is applied for 3 minutes. The investigators will take novel blood tests when the patient is having their routine bloods. Finally, the investigators will use a special camera to take specialised pictures of the small blood vessels under the tongue which will show blood flow through these vessels. The investigators will follow the recruited patients and determine if our extra data is better at determining who needs critical care. A significant proportion of patients may be too unwell or too distressed to consent to be part of this study. At the earliest opportunity, the investigators will ask patients when they have been stabilised and are able to give consent. If they say no, they will be removed from the study and their care will not be affected by this decision.
The results could help us identify septic shock as early as possible so that these unwell patients are identified early and get the correct treatment they need. This could mean starting advanced treatments usually found in the Intensive Care Unit very early on in a patient's journey.
The results could help us identify septic shock as early as possible so that these unwell patients are identified early and get the correct treatment they need. This could mean starting advanced treatments usually found in the Intensive Care Unit very early on in a patient's journey.
Conditions
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Sepsis
Study Design
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Observational Model Type
COHORT
Study Time Perspective
PROSPECTIVE
Study Groups
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Patients presenting to the Emergency Department with suspected sepsis
Patients who present with potential sepsis. This is characterised by their illness suspected to be from an infection and significantly unwell defined by one of two scoring systems, either the National Early Warning Score or quick Sequential Organ Failure Assessment
Measuring tissue oxygenation
Intervention Type
DIAGNOSTIC_TEST
Measuring oxygen content of arteries, capillaries and veins
Procalcitonin
Intervention Type
DIAGNOSTIC_TEST
Blood test
Mid-regional proadrenomedullin
Intervention Type
DIAGNOSTIC_TEST
Blood test looking at inflammation in the body
Hand-held video microscope
Intervention Type
DIAGNOSTIC_TEST
A handheld video microscope that looks at blood flow through the capillaries of the tongue
Interventions
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Measuring tissue oxygenation
Measuring oxygen content of arteries, capillaries and veins
Intervention Type
DIAGNOSTIC_TEST
Procalcitonin
Blood test
Intervention Type
DIAGNOSTIC_TEST
Mid-regional proadrenomedullin
Blood test looking at inflammation in the body
Intervention Type
DIAGNOSTIC_TEST
Hand-held video microscope
A handheld video microscope that looks at blood flow through the capillaries of the tongue
Intervention Type
DIAGNOSTIC_TEST
Other Intervention Names
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PCT
MR-proADM
Eligibility Criteria
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Inclusion Criteria
1. Differential diagnosis which includes infection
2. Change in the quick Sequential Organ Failure Assessment (qSOFA) ≥2 or National Early Warning Score 2 (NEWS2) score ≥5
3. Aged ≥18 years
2. Change in the quick Sequential Organ Failure Assessment (qSOFA) ≥2 or National Early Warning Score 2 (NEWS2) score ≥5
3. Aged ≥18 years
Exclusion Criteria
1. Traumatic injury
2. Rockwood frailty score ≥6
3. Critical care therapy previously believed to not be in patient's best interests
4. Critical care therapies-initiated pre-hospital. Critical care therapies defined as:
4.1 Mechanical ventilation 4.2 Vasopressor/inotrope therapy 4.3 Sedation or a general anaesthetic 4.4 Pre-hospital transfusion of blood products 4.5 Extra-corporeal support
5. Advanced directive refusing critical care therapies.
6. Acute cardiac failure
7. Active gastrointestinal bleed
8. Massive pulmonary embolism
9. ICU admission declined by critical care team
10. Treated in an acute hospital \<6 hours before presentation to the Emergency Department
2. Rockwood frailty score ≥6
3. Critical care therapy previously believed to not be in patient's best interests
4. Critical care therapies-initiated pre-hospital. Critical care therapies defined as:
4.1 Mechanical ventilation 4.2 Vasopressor/inotrope therapy 4.3 Sedation or a general anaesthetic 4.4 Pre-hospital transfusion of blood products 4.5 Extra-corporeal support
5. Advanced directive refusing critical care therapies.
6. Acute cardiac failure
7. Active gastrointestinal bleed
8. Massive pulmonary embolism
9. ICU admission declined by critical care team
10. Treated in an acute hospital \<6 hours before presentation to the Emergency Department
Minimum Eligible Age
18 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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University Hospital Southampton NHS Foundation Trust
OTHER
Sponsor Role
lead
Responsible Party
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Responsibility Role
SPONSOR
Principal Investigators
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Ahilanandan Dushianthan, PhD
Role: STUDY_DIRECTOR
University Hospital Southampton NHS Foundation Trust
James N Ward, BM
Role: PRINCIPAL_INVESTIGATOR
University Hospital Southampton NHS Foundation Trust
Locations
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University Hospital Southampton NHS Foundation Trust
Southampton, Hampshire, United Kingdom
Site Status
RECRUITING
Countries
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United Kingdom
Central Contacts
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Facility Contacts
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James N Ward, BM
Role: primary
References
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Hernandez G, Ospina-Tascon GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J, Friedman G, Castro R, Alegria L, Teboul JL, Cecconi M, Ferri G, Jibaja M, Pairumani R, Fernandez P, Barahona D, Granda-Luna V, Cavalcanti AB, Bakker J; The ANDROMEDA SHOCK Investigators and the Latin America Intensive Care Network (LIVEN); Hernandez G, Ospina-Tascon G, Petri Damiani L, Estenssoro E, Dubin A, Hurtado J, Friedman G, Castro R, Alegria L, Teboul JL, Cecconi M, Cecconi M, Ferri G, Jibaja M, Pairumani R, Fernandez P, Barahona D, Cavalcanti AB, Bakker J, Hernandez G, Alegria L, Ferri G, Rodriguez N, Holger P, Soto N, Pozo M, Bakker J, Cook D, Vincent JL, Rhodes A, Kavanagh BP, Dellinger P, Rietdijk W, Carpio D, Pavez N, Henriquez E, Bravo S, Valenzuela ED, Vera M, Dreyse J, Oviedo V, Cid MA, Larroulet M, Petruska E, Sarabia C, Gallardo D, Sanchez JE, Gonzalez H, Arancibia JM, Munoz A, Ramirez G, Aravena F, Aquevedo A, Zambrano F, Bozinovic M, Valle F, Ramirez M, Rossel V, Munoz P, Ceballos C, Esveile C, Carmona C, Candia E, Mendoza D, Sanchez A, Ponce D, Ponce D, Lastra J, Nahuelpan B, Fasce F, Luengo C, Medel N, Cortes C, Campassi L, Rubatto P, Horna N, Furche M, Pendino JC, Bettini L, Lovesio C, Gonzalez MC, Rodruguez J, Canales H, Caminos F, Galletti C, Minoldo E, Aramburu MJ, Olmos D, Nin N, Tenzi J, Quiroga C, Lacuesta P, Gaudin A, Pais R, Silvestre A, Olivera G, Rieppi G, Berrutti D, Ochoa M, Cobos P, Vintimilla F, Ramirez V, Tobar M, Garcia F, Picoita F, Remache N, Granda V, Paredes F, Barzallo E, Garces P, Guerrero F, Salazar S, Torres G, Tana C, Calahorrano J, Solis F, Torres P, Herrera L, Ornes A, Perez V, Delgado G, Lopez A, Espinosa E, Moreira J, Salcedo B, Villacres I, Suing J, Lopez M, Gomez L, Toctaquiza G, Cadena Zapata M, Orazabal MA, Pardo Espejo R, Jimenez J, Calderon A, Paredes G, Barberan JL, Moya T, Atehortua H, Sabogal R, Ortiz G, Lara A, Sanchez F, Hernan Portilla A, Davila H, Mora JA, Calderon LE, Alvarez I, Escobar E, Bejarano A, Bustamante LA, Aldana JL. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019 Feb 19;321(7):654-664. doi: 10.1001/jama.2019.0071.
Reference Type
BACKGROUND
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Hylander Moller M, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-e1143. doi: 10.1097/CCM.0000000000005337. No abstract available.
Reference Type
BACKGROUND
Parrott F. Length of stay , survival and organ support of admissions with septic shock to adult , general critical care units in England , Wales and Northern Ireland. 2014.
Reference Type
BACKGROUND
Liu Z, Meng Z, Li Y, Zhao J, Wu S, Gou S, Wu H. Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis. Scand J Trauma Resusc Emerg Med. 2019 Apr 30;27(1):51. doi: 10.1186/s13049-019-0609-3.
Reference Type
BACKGROUND
Sepsis: recognition, diagnosis and early management: (c) NICE (2017) Sepsis: recognition, diagnosis and early management. BJU Int. 2018 Apr;121(4):497-514. doi: 10.1111/bju.14179. No abstract available.
Reference Type
BACKGROUND
Jones S, Moulton C, Swift S, Molyneux P, Black S, Mason N, Oakley R, Mann C. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J. 2022 Mar;39(3):168-173. doi: 10.1136/emermed-2021-211572. Epub 2022 Jan 18.
Reference Type
BACKGROUND
Linder A, Arnold R, Boyd JH, Zindovic M, Zindovic I, Lange A, Paulsson M, Nyberg P, Russell JA, Pritchard D, Christensson B, Akesson P. Heparin-Binding Protein Measurement Improves the Prediction of Severe Infection With Organ Dysfunction in the Emergency Department. Crit Care Med. 2015 Nov;43(11):2378-86. doi: 10.1097/CCM.0000000000001265.
Reference Type
BACKGROUND
NHS Digital. Hospital Accident & Emergency Activity 2021-2022. 2022.
Reference Type
BACKGROUND
Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010 Oct 16;376(9749):1339-46. doi: 10.1016/S0140-6736(10)60446-1. Epub 2010 Oct 11.
Reference Type
BACKGROUND
NHS England (NHS-E). Critical Care Bed Capacity and Urgent Operations Cancelled 2019-20 Data.
Reference Type
BACKGROUND
Simpson HK, Clancy M, Goldfrad C, Rowan K. Admissions to intensive care units from emergency departments: a descriptive study. Emerg Med J. 2005 Jun;22(6):423-8. doi: 10.1136/emj.2003.005124.
Reference Type
BACKGROUND
Diagnostics Assessment Programme Diagnosis and monitoring of sepsis : procalcitonin testing ( ADVIA Centaur BRAHMS PCT assay , BRAHMS PCT Sensitive Kryptor assay , Elecsys BRAHMS PCT assay , LIAISON BRAHMS PCT assay. 2014.
Reference Type
BACKGROUND
Dilken O, Ergin B, Ince C. Assessment of sublingual microcirculation in critically ill patients: consensus and debate. Ann Transl Med. 2020 Jun;8(12):793. doi: 10.21037/atm.2020.03.222.
Reference Type
BACKGROUND
Ait-Oufella H, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J, Joffre J, Margetis D, Guidet B, Maury E, Offenstadt G. Mottling score predicts survival in septic shock. Intensive Care Med. 2011 May;37(5):801-7. doi: 10.1007/s00134-011-2163-y. Epub 2011 Mar 4.
Reference Type
BACKGROUND
Falotico JM, Shinozaki K, Saeki K, Becker LB. Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status. Front Med (Lausanne). 2020 Dec 7;7:614326. doi: 10.3389/fmed.2020.614326. eCollection 2020.
Reference Type
BACKGROUND
Vorwerk C, Coats TJ. The prognostic value of tissue oxygen saturation in emergency department patients with severe sepsis or septic shock. Emerg Med J. 2012 Sep;29(9):699-703. doi: 10.1136/emermed-2011-200160. Epub 2011 Sep 21.
Reference Type
BACKGROUND
Haertel F, Reisberg D, Peters M, Nuding S, Schroeder J, Werdan K, Ebelt H. Prognostic Value of Tissue Oxygen Saturation Using a Vascular Occlusion Test in Patients in the Early Phase of Multiorgan Dysfunction Syndrome. Shock. 2019 Jun;51(6):706-712. doi: 10.1097/SHK.0000000000001225.
Reference Type
BACKGROUND
AnaesthesiaUK. Principles of pulse oximetry [Internet]. AnaesthesiaUK. 2004. Available from: https://www.frca.co.uk/article.aspx?articleid=332
Reference Type
BACKGROUND
Lipcsey M, Eastwood GM, Woinarski NC, Bellomo R. Near-infrared spectroscopy of the thenar eminence: comparison of dynamic testing protocols. Crit Care Resusc. 2012 Jun;14(2):142-7.
Reference Type
BACKGROUND
Macdonald SP, Brown SG. Near-infrared spectroscopy in the assessment of suspected sepsis in the emergency department. Emerg Med J. 2015 May;32(5):404-8. doi: 10.1136/emermed-2013-202956. Epub 2013 Oct 23.
Reference Type
BACKGROUND
Pinsky MR. Functional hemodynamic monitoring. Crit Care Clin. 2015 Jan;31(1):89-111. doi: 10.1016/j.ccc.2014.08.005.
Reference Type
BACKGROUND
Guyette FX, Gomez H, Suffoletto B, Quintero J, Mesquida J, Kim HK, Hostler D, Puyana JC, Pinsky MR. Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients. J Trauma Acute Care Surg. 2012 Apr;72(4):930-5. doi: 10.1097/TA.0b013e31823d0677.
Reference Type
BACKGROUND
De Backer D, Hollenberg S, Boerma C, Goedhart P, Buchele G, Ospina-Tascon G, Dobbe I, Ince C. How to evaluate the microcirculation: report of a round table conference. Crit Care. 2007;11(5):R101. doi: 10.1186/cc6118.
Reference Type
BACKGROUND
Thooft A, Favory R, Salgado DR, Taccone FS, Donadello K, De Backer D, Creteur J, Vincent JL. Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care. 2011;15(5):R222. doi: 10.1186/cc10462. Epub 2011 Sep 21.
Reference Type
BACKGROUND
Scorcella C, Damiani E, Domizi R, Pierantozzi S, Tondi S, Carsetti A, Ciucani S, Monaldi V, Rogani M, Marini B, Adrario E, Romano R, Ince C, Boerma EC, Donati A. MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study. Ann Intensive Care. 2018 May 15;8(1):64. doi: 10.1186/s13613-018-0411-9.
Reference Type
BACKGROUND
Massey MJ, Shapiro NI. A guide to human in vivo microcirculatory flow image analysis. Crit Care. 2016 Feb 10;20:35. doi: 10.1186/s13054-016-1213-9.
Reference Type
BACKGROUND
Andaluz-Ojeda D, Nguyen HB, Meunier-Beillard N, Cicuendez R, Quenot JP, Calvo D, Dargent A, Zarca E, Andres C, Nogales L, Eiros JM, Tamayo E, Gandia F, Bermejo-Martin JF, Charles PE. Superior accuracy of mid-regional proadrenomedullin for mortality prediction in sepsis with varying levels of illness severity. Ann Intensive Care. 2017 Dec;7(1):15. doi: 10.1186/s13613-017-0238-9. Epub 2017 Feb 10.
Reference Type
BACKGROUND
Saeed K, Legramante JM, Angeletti S, Curcio F, Miguens I, Poole S, Tascini C, Sozio E, Del Castillo JG. Mid-regional pro-adrenomedullin as a supplementary tool to clinical parameters in cases of suspicion of infection in the emergency department. Expert Rev Mol Diagn. 2021 Apr;21(4):397-404. doi: 10.1080/14737159.2021.1902312. Epub 2021 Mar 29.
Reference Type
BACKGROUND
Baldira J, Ruiz-Rodriguez JC, Wilson DC, Ruiz-Sanmartin A, Cortes A, Chiscano L, Ferrer-Costa R, Comas I, Larrosa N, Fabrega A, Gonzalez-Lopez JJ, Ferrer R. Biomarkers and clinical scores to aid the identification of disease severity and intensive care requirement following activation of an in-hospital sepsis code. Ann Intensive Care. 2020 Jan 15;10(1):7. doi: 10.1186/s13613-020-0625-5.
Reference Type
BACKGROUND
Ma H, Liu H, Wu C, Huang L. Diagnostic Value of Serum Heparin Binding Protein, Blood Lactic Acid Combined with hs-CRP in Sepsis and Its Relationship with Prognosis. Evid Based Complement Alternat Med. 2021 Nov 9;2021:5023733. doi: 10.1155/2021/5023733. eCollection 2021.
Reference Type
BACKGROUND
Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Vol. 17, Updated report of a working party. London; 2017. 318-318 p.
Reference Type
BACKGROUND
You JS, Park YS, Chung SP, Lee HS, Jeon S, Kim WY, Shin TG, Jo YH, Kang GH, Choi SH, Suh GJ, Ko BS, Han KS, Shin JH, Kong T; Korean Shock Society (KoSS) Investigators. Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock. Crit Care. 2022 Feb 11;26(1):43. doi: 10.1186/s13054-022-03899-0.
Reference Type
BACKGROUND
Massey MJ, Larochelle E, Najarro G, Karmacharla A, Arnold R, Trzeciak S, Angus DC, Shapiro NI. The microcirculation image quality score: development and preliminary evaluation of a proposed approach to grading quality of image acquisition for bedside videomicroscopy. J Crit Care. 2013 Dec;28(6):913-7. doi: 10.1016/j.jcrc.2013.06.015. Epub 2013 Aug 21.
Reference Type
BACKGROUND
Other Identifiers
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CRI0436
Identifier Type: -
Identifier Source: org_study_id