Dexmedetomidine Versus Propofol for Continuous Sedation in the Intensive Care Unit (ICU) - Full Text View

Sponsored by:	Orion Corporation, Orion Pharma
Information provided by:	Orion Corporation, Orion Pharma
ClinicalTrials.gov Identifier:	NCT00479661

Purpose

Patients in the ICU who need help with their breathing are put onto a machine called a ventilator and are also given a medicine, called a sedative, which helps them to sleep and makes them more comfortable. Propofol is a sedative that is routinely used for these purposes.

For most patients the aim of sedation is to make them sleepy but still able to respond to nursing staff (light sedation).

Dexmedetomidine is a new sedative for use in intensive care and in this clinical study,dexmedetomidine is compared to propofol. It is thought that dexmedetomidine might be slightly better at allowing patients to be sleepy but still respond to people around them. It also does not appear to affect patient's breathing. The purpose of this study is to test whether dexmedetomidine really does have these advantages compared to propofol.

In this study, we hope to show that: dexmedetomidine is at least as good as propofol in helping patients to sleep better and making them more comfortable, and that they are able to communicate and cooperate better with the staff treating them, and that patients treated with dexmedetomidine require a shorter time on the ventilator than those treated with propofol.

Condition	Intervention	Phase
Continuous Sedation in Initially Sedated Adults in ICU	Drug: Dexmedetomidine Drug: Propofol	Phase III

Drug Information available for: Dexmedetomidine Dexmedetomidine hydrochloride Propofol

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Active Control, Parallel Assignment, Safety/Efficacy Study
Official Title:	A Prospective, Multi-Centre, Randomised, Double-Blind Comparison of Intravenous Dexmedetomidine With Propofol for Continuous Sedation of Ventilated Patients in Intensive Care Unit

Further study details as provided by Orion Corporation, Orion Pharma:

Primary Outcome Measures:

Depth of sedation using the RASS. The target RASS range (target depth of sedation) should be 0 to -3 for a patient to be included in the study. The target may be amended during the study treatment, if clinically required. [ Time Frame: 2 hourly and before each rescue treatment dose during the treatment period and the 48-hour follow-up ] [ Designated as safety issue: No ]
Duration of mechanical ventilation [ Time Frame: Start and stop times of mechanical ventilation while the patient is treated in the ICU ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Nurse's assessment of subject communication with visual analogue scales (VAS) [ Time Frame: At the end of each nursing shift during study treatment and 48 h follow-up period in the ICU ] [ Designated as safety issue: No ]
Length of ICU stay [ Time Frame: Admission and discharge dates and times during the current ICU treatment period ] [ Designated as safety issue: No ]

Estimated Enrollment:	500
Study Start Date:	May 2007
Estimated Study Completion Date:	May 2009
Estimated Primary Completion Date:	May 2009 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental Dexmedetomidine	Drug: Dexmedetomidine Continuous infusion
2: Active Comparator Propofol	Drug: Propofol Continuous infusion

Detailed Description:

This is a phase III, multi-centre, prospective, randomised, double-blind, double-dummy, active comparator study. The study consists of three periods:

screening, double-dummy treatment and follow-up period.

All patients admitted to ICU will be pre-screened according to inclusion and exclusion criteria prior to informed consent using available clinical data.

Informed consent, screening and randomisation procedures should be completed within 72 hours from the time of admission to ICU and within 48 hours from starting continuous sedation. Eligible study subjects requiring light to moderate sedation (Richmond Agitation-Sedation Scale [RASS] = 0 to -3) will be randomised to either continue on propofol or switch to dexmedetomidine. Patients should not have received any other continuously or regularly administered sedative agent than propofol during the last 12 hours except for opioid analgesics. Study treatments will be titrated to achieve an individually targeted sedation range determined on a daily basis. Rescue treatment (i.e. midazolam boli) may be given if needed to achieve the target depth of sedation. Continued need for sedation will be assessed at a daily sedation stop, conducted at the same time each day. First sedation stop may be 12-36 hours from randomisation, depending on the time of day the study subject is randomised. The duration of study treatment is limited to a maximum of 14 days from randomisation. Following withdrawal of sedation, study subjects will be monitored for 48 hours and contacted by telephone 31 and 45 days after randomisation.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Age more than 18 years
Clinical need for sedation of an initially intubated (or tracheotomised) and ventilated (with inspiratory assistance) patient
Prescribed light to moderate sedation (target RASS = 0 to -3) using propofol
Patients should be randomised within 72 hours from ICU admission and within 48 hours of commencing continuous sedation in the ICU
Patients should have an expected requirement for sedation more than 24 hours from time of randomisation
Written informed consent must be obtained according to local regulations before starting any study procedures other than pre-screening

Exclusion Criteria:

Acute severe intracranial or spinal neurological disorder due to vascular causes, infection, intracranial expansion or injury
Uncompensated acute circulatory failure at time of randomisation (severe hypotension with mean arterial pressure [MAP] < 55 mmHg despite volume and pressors)
Severe bradycardia (heart rate [HR] < 50 beats/min)
AV-conduction block II-III (unless pacemaker installed)
Severe hepatic impairment (bilirubin > 101 µmol/l)
Need for muscle relaxation at the time of randomisation (may only be used for intubation and initial stabilization)
Loss of hearing or vision, or any other condition which would significantly interfere with the collection of study data
Burn injuries requiring regular anaesthesia or surgery
Use of centrally acting α2 agonists or antagonists at the time of randomisation, notably clonidine
Patients who have or are expected to have treatment withdrawn or withheld due to poor prognosis
Patients receiving sedation for therapeutic indications rather than to tolerate the ventilator (e.g. epilepsy)
Patients who are unlikely to require continuous sedation during mechanical ventilation (e.g. Guillain-Barré syndrome)
Patients who are unlikely to be weaned from mechanical ventilation e.g. diseases/injuries primarily affecting the neuromuscular function of the respiratory apparatus such as clearly irreversible disease requiring prolonged ventilatory support (e.g. high spinal cord injury or advanced amyotrophic lateral sclerosis)
Distal paraplegia
Positive pregnancy test or currently lactating
Received any investigational drug within the preceding 30 days
Concurrent participation in any other interventional study (any study in which patients are allocated to different treatment groups and/or non-routine diagnostic or monitoring procedures are performed)
Previous participation in this study
Any other condition which, in the investigator's opinion, would make it detrimental for the subject to participate in the study

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00479661

Contacts

Contact: Esko Ruokonen, MD

+358 17 173424

esko.ruokonen@kuh.fi

Show 46 Study Locations

Sponsors and Collaborators

Orion Corporation, Orion Pharma

Investigators

Principal Investigator:	Esko Ruokonen, MD	Kuopio University Hospital
Study Director:	Kati Kaijasilta, MSc (Pharm)	Orion Corporation, Orion Pharma

More Information

No publications provided

Responsible Party:	Orion corporation, Orion Pharma, Clinical R&D ( Kati Kaijasilta )
Study ID Numbers:	3005012, EudraCT 2006-006030-17
Study First Received:	May 25, 2007
Last Updated:	January 28, 2009
ClinicalTrials.gov Identifier:	NCT00479661 History of Changes
Health Authority:	Belgium: Directorate general for the protection of Public health: Medicines; Finland: National Agency for Medicines; Germany: Federal Institute for Drugs and Medical Devices; Netherlands: The Central Committee on Research Involving Human Subjects (CCMO); United Kingdom: Medicines and Healthcare Products Regulatory Agency; Switzerland: Swissmedic

Keywords provided by Orion Corporation, Orion Pharma:

initial sedation
mechanical ventilation

Study placed in the following topic categories:

Anesthetics, Intravenous
Neurotransmitter Agents
Adrenergic alpha-Agonists
Adrenergic Agents
Anesthetics
Central Nervous System Depressants
Adrenergic Agonists

Anesthetics, General
Analgesics, Non-Narcotic
Hypnotics and Sedatives
Dexmedetomidine
Analgesics
Peripheral Nervous System Agents
Propofol

Additional relevant MeSH terms:

Anesthetics, Intravenous
Neurotransmitter Agents
Adrenergic alpha-Agonists
Molecular Mechanisms of Pharmacological Action
Adrenergic Agents
Physiological Effects of Drugs
Anesthetics
Central Nervous System Depressants
Adrenergic Agonists
Pharmacologic Actions

Sensory System Agents
Anesthetics, General
Analgesics, Non-Narcotic
Therapeutic Uses
Hypnotics and Sedatives
Peripheral Nervous System Agents
Dexmedetomidine
Analgesics
Propofol
Central Nervous System Agents

ClinicalTrials.gov processed this record on May 07, 2009