Dexmedetomidine Versus Midazolam for Continuous Sedation in the Intensive Care Unit (ICU) (MIDEX)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Orion Corporation, Orion Pharma
ClinicalTrials.gov Identifier:
NCT00481312
First received: May 31, 2007
Last updated: May 4, 2012
Last verified: November 2009
  Purpose

Patients in 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. Midazolam 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 midazolam. 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 midazolam.

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


Condition Intervention Phase
Continuous Sedation in Initially Sedated Adults in ICU
Drug: Dexmedetomidine
Drug: Midazolam
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Prospective, Multi-centre, Randomised, Double-blind Comparison of Intravenous Dexmedetomidine With Midazolam for Continuous Sedation of Ventilated Patients in Intensive Care Unit

Resource links provided by NLM:


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: RASS score will be assessed approximately 2 hourly during the treatment period and during the 48-hour follow-up period ] [ Designated as safety issue: Yes ]
  • Duration of mechanical ventilation the number of days the patient receives mechanical ventilation will be recorded [ Time Frame: This variable will be dependent on the individual patient and the number of days they require mechanical ventilation . ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Nurse's assessment of subject communication with visual analogue scales (VAS)Patients rousability and ability to co-operate and communicate will be measured using a visual analogue scale. [ Time Frame: This will be measured at the end of every nursing shift whilst the patient remains on study treatment (maximum 14 days) ] [ Designated as safety issue: Yes ]
  • Length of ICU stay [ Time Frame: Number of days a patient is in ICU which will vary depending on the underlying illness of the patient ] [ Designated as safety issue: No ]

Enrollment: 501
Study Start Date: June 2007
Study Completion Date: October 2009
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1
Dexmedetomidine
Drug: Dexmedetomidine
Continuous Infusion
Active Comparator: 2
Midazolam
Drug: Midazolam
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 midazolam or switch to dexmedetomidine. Patients should not have received any other continuously or regularly administered sedative agent than midazolam infusion 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. propofol 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 18 years and over
  • 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 midazolam infusion
  • 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 of at least 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 MAP < 55 mmHg despite volume and pressors)
  • Severe bradycardia (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 (see section 5.7 for prior and concomitant treatments)
  • Known allergy to any of the study drugs or any excipients of the study drugs
  • 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 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
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00481312

  Hide Study Locations
Locations
Belgium
UZ Brussel, Intensive Care Dept. Laarbeeklaan 101
Brussels, Belgium, 1090
ULB Erasme, Route de Lennik
Brussels, Belgium, 1070
Universitaer Ziekenhuis Gent, Intensieve Zorgen, De Pintelaan 185
Gent, Belgium, 9000
CHU de Liege (Sart Tilman), Domaine de Sart-Tilman
Liege, Belgium, 3000
Estonia
North Estonian Regional Hospital, Dept. of Postoperative Intensive Care, J. Sutiste Tee 18
Tallinn, Estonia, 13419
East Tallinn Central Hospital, Ravi Stret 18
Tallinn, Estonia, 10138
North Estonian Regional Hospital, Centre of Intensive Care, J. Sutiste Tee 18
Tallinn, Estonia, 13419
Tartu University Hospistal, Clinic of Anesthesiology and Intensive Care, L. Puusepa 8
Tartu, Estonia, 51014
Finland
Oulu University Hospital, Kajaanintie 50
Oulu, Finland, 90029 OYS
Tampere University Hospital, ICU
Tampere, Finland, 33521
France
Centre Hospitalier Universitaire d'Angers, Reanimation medicale est de Mededicne Hyperbare, 4 Rue Larrey
Angers cedex 9, France, 49933
Centre Hospitalier Victor Dupouy Hopital Dupuytren, Service Reanimation Polyvalente, 69, Rue du Lt Colonel Prud'hon
Argenteuil, France, 95107
Centre Hospitalier Universitaire de Grenoble, Service de Reanimation Medicale, Boulevard de la Chantourne, BP 217
Grenoble cedex 09, France, 38043
Centre Hospitalier La Roche sur Yon CHD les Oudaireis, Service Reanimation CHD la Roche sur Yon, Les Oudairies
La Roche sur Yon Cedex, France, 85925
Hopital Albert Calmette, Boulevard Du Pr. Jules Leclercq
Lille, France, 59037
Centre Hospitalier Universitaire Limoges Hopital Dupuytren, Service de Reanimation Polyvalente, 2, Avenue Martin Luther King
Limoges, France, 87042
Centre Hospitalier Universitaire d'Orleans, Reanimation Medicale, 1, rue Prote Madeleine, BP 2439
Orleans cedex 1, France, 45032
Hopital Bichat-Claude, Dept. D'Anasehesie et Reanimation Chirurgicale, 46, rue Henri-Huchard
Paris, France, 75018
Groupe Hospitalier Cochin Saint Vincent de Paul, Service de Reanimation Medicale, 27 Rue du Faubourg Saint Jacques
Paris, France, 75679
Hopital Foch, Service Renimation, 40 Rue Worth, Suresnes Hauts de Seine
Paris, France, 92150
Centre Hospitalier Universitaire de Poitiers, Reanimation Medicale, 2, Rue de la Miletrie
Poitiers, France, 86021
Centre Hospitalier Regional et Universitaire - Hopital Bretonneau Service Reanimation Medicale Polyvalente, 2, Boulevard Tonnelle, Tours cedex 9
Tours, France, 37044
Germany
Universitatsklinikum Bonn, Klinik u. Poliklinik f. Anasthesiologie u. Operative Intensivmedizin, Sigmund-Freud-Strasse 25
Bonn, Germany, 53105
Universitatsklinikum Greifswald, Klinik u. Poliklinik f. Anasthesiologie u. Intensivmedizin, Friedrich-Loeffler-Str. 23b
Greifswald, Germany, 17475
Universitatsklinikum Tubingen, Klinik fur Anasthesiologie und Intensivmedizin, Hoppe-Seyler-Strasse 3
Tubingen, Germany, 72076
Netherlands
VU Medisch Centrum, De Boelelaan 1117
Amsterdam, Netherlands, 1081 HV
Gelre Hospitals - Locatie Lucas, A.Schweitzerlaan 32
Apeldoorn, Netherlands, 7334 DZ
Amphia Ziekenhuis, Dept. Intensieve Zorgen, Molengracht 21
Breda, Netherlands, 4818
Albert Schweitzer Hospital, Locatie Dordwikj, Albert Schweitzerplaats 25
Dordrecht, Netherlands, 3318 AT
Kennemer Hospital, Boeerhaavelaan 29
Haarlem, Netherlands, 2035 RC
Saint Elisabeth Ziekenhuis, Dept. Intensieve Zorgen, Hilvarenbeekseweg 60
Tilburg, Netherlands, 5022 GC
Viecuri MC voor Noord-Limburg, Locatie Venlo, Dept. Intensieve Zorgen, Tegelseweg 210
Venlo, Netherlands, 5912 BL
Isala Klinieken, Locatie Weezenlanden, Groot Wezenland 20
Zwolle, Netherlands, 8011 JW
Norway
Haukeland University Hospital, Intensive Care Unit, Jonas Liesvei 65
Bergen, Norway, 5021
Rikshospitalet, Universitetsklinikk, Sognsvannsveien 20
Oslo, Norway, 0027
Aker Universtetssykehus HF, Anestesiavdelingen, Trondheimsveien 235
Oslo, Norway, 0514
Ulleval University Hospital, Medical and Surgical ICU, Kirkeveien 166
Oslo, Norway, 0450
Switzerland
Inselspital, Freiburgstrasse 4
Bern, Switzerland, CH-3010
Kantonsspital Winterthur, Brauerstrasse 15,
Winterthur, Switzerland, 8401
Universitatsspital Zurich, Klinik fur Innere Medizin, Intensivstation, Ramistrasse 100
Zurich, Switzerland, 8091
United Kingdom
Birmingham Heartlands Hospital, Bordesely Green East
Birmingham, United Kingdom, B9 5SS
University Hospital Birmingham, Department of Anaesthesia, Queen Elizabeth Hospital,
Birmingham, United Kingdom, B15 2TH
Derriford Hospital, Dept. of Intensive Care Level 4, Derriford Road
Plymouth, United Kingdom, PL6 8DH
Sponsors and Collaborators
Orion Corporation, Orion Pharma
Investigators
Principal Investigator: Stephan Jakob, MD PhD Insel Spital, Bern CH-3010 Switzerland
Study Director: Angela Ruck, BSc PhD Orion Pharma R&D Nottingham England
  More Information

No publications provided by Orion Corporation, Orion Pharma

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Orion Corporation, Orion Pharma
ClinicalTrials.gov Identifier: NCT00481312     History of Changes
Other Study ID Numbers: 3005013
Study First Received: May 31, 2007
Last Updated: May 4, 2012
Health Authority: Finland: Finnish Medicines Agency
Belgium: Federal Agency for Medicines and Health Products, FAMHP
Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)
Germany: Federal Institute for Drugs and Medical Devices
Switzerland: Swissmedic
United Kingdom: Medicines and Healthcare Products Regulatory Agency

Keywords provided by Orion Corporation, Orion Pharma:
Initial Sedation
Mechanical ventilation

Additional relevant MeSH terms:
Midazolam
Dexmedetomidine
Adjuvants, Anesthesia
Central Nervous System Agents
Therapeutic Uses
Pharmacologic Actions
Hypnotics and Sedatives
Central Nervous System Depressants
Physiological Effects of Drugs
Anti-Anxiety Agents
Tranquilizing Agents
Psychotropic Drugs
Anesthetics, Intravenous
Anesthetics, General
Anesthetics
GABA Modulators
GABA Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Adrenergic alpha-2 Receptor Agonists
Adrenergic alpha-Agonists
Adrenergic Agonists
Adrenergic Agents

ClinicalTrials.gov processed this record on August 19, 2014