The Modifying the Impact of ICU-Associated Neurological Dysfunction-USA (MIND-USA) Study - Full Text View

Purpose

The long-term objective of the MIND-USA (Modifying the Impact of ICU-Induced Neurological Dysfunction-USA) Study is to define the role of antipsychotics in the management of delirium in vulnerable critically ill patients. We and others have shown that delirium is an independent predictor of more death, longer stay, higher cost, and long-term cognitive impairment often commensurate with moderate dementia. The rapidly expanding aging ICU population is especially vulnerable to develop delirium, with 7 of 10 medical and surgical ICU patients developing this organ dysfunction. Antipsychotics are the first-line pharmacological agents recommended to treat delirium, and over the past 30 years they gained widespread use in hospitalized patients globally prior to adequate testing of efficacy and safety for this indication. Haloperidol, the most commonly chosen antipsychotic, is used by over 80% of ICU doctors for delirium, while atypical antipsychotics are prescribed by 40%. Antipsychotics safety concerns include lethal cardiac arrhythmias, extrapyramidal symptoms, and the highly publicized increased mortality associated with their use in non-ICU geriatric populations. The overarching hypothesis is that administration of typical and atypical antipsychotics—haloperidol and ziprasidone, in this case—to critically ill patients with delirium will improve short- and long-term clinical outcomes, including days alive without acute brain dysfunction (referred to as delirium/coma-free days or DCFDs) over a 14-day period; 30-day, 90-day, and 1-year survival; ICU length of stay; incidence, severity, and/or duration of long-term neuropsychological dysfunction; and quality of life at 90-day and 1-year. To test these hypotheses, the MIND-USA Study will be a multi-center, double-blind, randomized, placebo-controlled investigation in 561 critically ill, delirious medical/surgical ICU patients who are (a) on mechanical ventilation or non-invasive positive pressure ventilation or (b) in shock on vasopressors. In each group (haloperidol, ziprasidone, and placebo), 187 patients will be enrolled and treated until delirium has resolved for 48 hours or to 14 days (whichever occurs first) and followed for 1 year.

Condition	Intervention	Phase
Delirium Impaired Cognition Long Term Psychologic Disorders	Drug: Haloperidol Drug: Ziprasidone Drug: Placebo	Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	The MIND-USA Study: Modifying the Impact of ICU-Associated Neurological Dysfunction

Resource links provided by NLM:

MedlinePlus related topics: Delirium

Drug Information available for: Haloperidol Haloperidol decanoate Ziprasidone hydrochloride Ziprasidone Ziprasidone mesylate

U.S. FDA Resources

Further study details as provided by Vanderbilt University:

Primary Outcome Measures:

Delirium/coma-free days [ Time Frame: 14 days ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Survival [ Time Frame: 30-day, 90-day, and 1-year ] [ Designated as safety issue: No ]
Delirium duration [ Time Frame: 14 days ] [ Designated as safety issue: No ]
ICU length of stay [ Time Frame: 1 to 90 days ] [ Designated as safety issue: No ]
Time to ICU discharge, represented by readiness for ICU discharge indicated by a physician order for transfer to a lower level of care even if a bed availability problems prevent actual discharge from the ICU.
Hospital length of stay [ Time Frame: 1 to 90 days ] [ Designated as safety issue: No ]
Ventilator-free days [ Time Frame: 14 days ] [ Designated as safety issue: No ]
ICU readmission [ Time Frame: 1 to 90 days ] [ Designated as safety issue: No ]
Hospital readmission [ Time Frame: 1 to 365 days ] [ Designated as safety issue: No ]
Neuropsychological dysfunction [ Time Frame: 3-month, 12-month ] [ Designated as safety issue: No ]
Assessed using a battery of cognitive tests.
Quality of life [ Time Frame: 3-month, 12-month ] [ Designated as safety issue: No ]
Posttraumatic stress disorder [ Time Frame: 3-month, 12-month ] [ Designated as safety issue: No ]
QTc prolongation [ Time Frame: 14 days ] [ Designated as safety issue: Yes ]
Extrapyramidal symptoms [ Time Frame: 14 days ] [ Designated as safety issue: Yes ]
Neuroleptic malignant syndrome [ Time Frame: 14 days ] [ Designated as safety issue: Yes ]


Estimated Enrollment:	876
Study Start Date:	December 2011
Estimated Study Completion Date:	February 2017
Estimated Primary Completion Date:	July 2016 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Haloperidol Haloperidol	Drug: Haloperidol Haloperidol, up to 10mg q12 hours, will be administered intravenously (IV) by bolus over up to 5 minutes at concentrations of 5mg/mL. Patient will only receive IV while in the ICU. Other Name: Haldol
Experimental: Ziprasidone Ziprasidone	Drug: Ziprasidone Ziprasidone, up to 20mg q12 hours, will be administered intravenously (IV) by bolus over up to 5 minutes at concentrations of 10mg/mL. Patient will only receive IV while in the ICU. Other Name: Geodon
Placebo Comparator: Placebo Placebo	Drug: Placebo Placebo, up to 10mL q12 hours, will be administered intravenously (IV) by bolus over up to 5 minutes. Patient will only receive IV while in the ICU. Other Name: Placebo

Detailed Description:

The primary and secondary outcomes of the MIND-USA investigation will be analyzed both according to the individual comparisons by group of "haloperidol treated" vs. "placebo treated" and "ziprasidone treated" vs. "placebo treated" and also the combined grouping of both antipsychotics ("haloperidol plus ziprasidone treated" patients vs. "placebo treated" patients).

Eligibility


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

Criteria

Inclusion Criteria:

adult patients (≥18 years old)
in a medical and/or surgical ICU
on mechanical ventilation or non-invasive positive pressure ventilation (NIPPV), and/or requiring vasopressors due to shock
delirious (according to the CAM-ICU)

Exclusion Criteria:

Rapidly resolving organ failure criteria, indicated by planned immediate discontinuation of mechanical ventilation, NIPPV, and/or vasopressors at the time of screening for study enrollment
Pregnancy or breastfeeding (negative pregnancy test required prior to enrollment of female patients of childbearing age)
Severe dementia or neurodegenerative disease, defined as either impairment that prevents the patient from living independently at baseline or IQCODE >4.5, measured using a patient's qualified surrogate, mental illness requiring long-term institutionalization, acquired or congenital mental retardation, Parkinson's disease, Huntington's disease, and/or coma or another severe deficit due to structural brain disease such as stroke, intracranial hemorrhage, cranial trauma, intracranial malignancy, anoxic brain injury, or cerebral edema.
History of torsades de pointes, documented baseline QT prolongation (congenital long QT syndrome), or QTc >500 ms at screening due to refractory electrolyte abnormalities, other drugs, or thyroid disease
Ongoing maintenance therapy with typical or atypical antipsychotics
History of neuroleptic malignant syndrome (NMS), haloperidol allergy, or ziprasidone allergy
Expected death within 24 hours of enrollment or lack of commitment to aggressive treatment by family or the medical team (e.g., likely withdrawal of life support measures within 24 hours of screening)
Inability to obtain informed consent from an authorized representative within 72 hours of meeting all inclusion criteria, i.e., developing qualifying organ dysfunction criteria.

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: NCT01211522

Contacts


Contact: E. Wesley Ely, MD, MPH	615-936-3395	wes.ely@vanderbilt.edu
Contact: Timothy D Girard, MD, MSCI	615-936-1010	timothy.girard@vanderbilt.edu

Locations


United States, Colorado
Denver Health/University of Colorado Health Sciences Center	Recruiting
Denver, Colorado, United States, 80204-4507
Contact: Ivor S Douglas, MD 303-436-5905 idouglas@dhha.org
Principal Investigator: Ivor S Douglas, MD
United States, Connecticut
Yale University Medical Center	Recruiting
New Haven, Connecticut, United States, 06520-8057
Contact: Margaret A Pisani, MD 203-785-3627 margaret.pisani@yale.edu
Principal Investigator: Margaret A Pisani, MD
United States, Indiana
Indiana University	Recruiting
Indianapolis, Indiana, United States, 46202-2915
Contact: Babar A. Khan, MD 317-423-5674 bakhan@indiana.edu
Contact: Malaz A. Boustani, MD 317-423-5633 mboustan@iupui.edu
Principal Investigator: Babar A. Khan, MD
Principal Investigator: Malaz A. Boustani, MD
United States, Iowa
University of Iowa	Withdrawn
Iowa City, Iowa, United States, 52242
United States, Maryland
University of Maryland Medical Center	Recruiting
Baltimore, Maryland, United States, 21201
Contact: Peter Rock, MD, MBA 410-328-8919 prock@anes.umm.edu
Principal Investigator: Peter Rock, MD, MBA
United States, Massachusetts
Brigham and Women's Hospital	Recruiting
Boston, Massachusetts, United States, 02115
Contact: Robert L Owens, MD 617-983-7489 rowens@partners.org
Principal Investigator: Robert L Owens, MD
Massachusetts General Hospital	Withdrawn
Boston, Massachusetts, United States, 02114-2696
United States, Michigan
University of Michigan Health System	Recruiting
Ann Arbor, Michigan, United States, 48109-5360
Contact: Robert C Hyzy, MD 734-936-5201 rhyzy@med.umich.edu
Principal Investigator: Robert C Hyzy, MD
United States, New York
Albert Einstein Medical College-Montefiore Medical Center	Recruiting
Bronx, New York, United States, 10461
Contact: Michelle Ng Gong, MD, MS 718-430-3712 mgong@montefiore.org
Principal Investigator: Michelle Ng Gong, MD, MS
United States, North Carolina
University of North Carolina - Chapel Hill	Recruiting
Chapel Hill, North Carolina, United States, 27599-7248
Contact: Shannon S Carson, MD 919-966-2531 shannon_carson@med.unc.edu
Principal Investigator: Shannon S Carson, MD
Moses Cone Health System	Recruiting
Greensboro, North Carolina, United States, 27410
Contact: Daniel J Feinstein, MD 336-832-2432 daniel.feinstein@mosescone.com
Principal Investigator: Daniel J Feinstein, MD
Wake Forest University	Withdrawn
Winston-Salem, North Carolina, United States, 27157
United States, Ohio
The Ohio State Medical Center	Recruiting
Columbus, Ohio, United States, 43210-1228
Contact: Matthew C. Exline, MD, MPH 614-293-4925 matthew.exline@osumc.edu
Principal Investigator: Matthew C. Exline, MD, MPH
United States, Pennsylvania
University of Pennsylvania	Withdrawn
Philadelphia, Pennsylvania, United States, 19104-6205
United States, Tennessee
Vanderbilt University Medical Center	Recruiting
Nashville, Tennessee, United States, 37232-8300
Contact: Wes E. Ely, MD, MPH 615-936-3702 wes.ely@vanderbilt.edu
Contact: Tim Girard, MD, MPH 1-615-936-3702 timothy.girard@vanderbilt.edu
United States, Texas
Baylor Health Care System	Withdrawn
Dallas, Texas, United States, 75206
United States, Washington
University of Washington	Recruiting
Seattle, Washington, United States, 98195-9472
Contact: Catherine Hough, MD 206-744-3356 cterrlee@uw.edu
Principal Investigator: Catherine Hough, MD

Sponsors and Collaborators

Vanderbilt University

Investigators


Principal Investigator:	E. Wesley Ely, MD, MPH	Vanderbilt University

More Information

No publications provided


Responsible Party:	Wes Ely, Professor of Medicine, Vanderbilt University
ClinicalTrials.gov Identifier:	NCT01211522 History of Changes
Other Study ID Numbers:	AG035117-01A1, 101082
Study First Received:	September 28, 2010
Last Updated:	June 19, 2014
Health Authority:	United States: Food and Drug Administration United States: Institutional Review Board

Keywords provided by Vanderbilt University:


Delirium Intensive care Mechanical ventilation Antipsychotic Haloperidol Ziprasidone	Randomized Placebo Sepsis Sedation Long-term cognitive impairment

Additional relevant MeSH terms:


Haloperidol Haloperidol decanoate Ziprasidone Anti-Dyskinesia Agents Antiemetics Antipsychotic Agents Autonomic Agents Central Nervous System Agents Central Nervous System Depressants Dopamine Agents Dopamine Antagonists	Gastrointestinal Agents Molecular Mechanisms of Pharmacological Action Neurotransmitter Agents Peripheral Nervous System Agents Pharmacologic Actions Physiological Effects of Drugs Psychotropic Drugs Serotonin Agents Serotonin Antagonists Therapeutic Uses Tranquilizing Agents

ClinicalTrials.gov processed this record on March 03, 2015