A Safety and Efficacy Study of Dexmedetomidine in ICU Patients Requiring Continuous Sedation

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Hospira, Inc.
ClinicalTrials.gov Identifier:
NCT00216190
First received: August 31, 2005
Last updated: July 22, 2015
Last verified: July 2015

August 31, 2005
July 22, 2015
March 2005
Not Provided
The percentage of time spent within the protocol specified sedation range (Richmond Agitation-Sedation Scale [RASS] range of -2 to +1) [ Time Frame: Preinfusion, Treatment period: every 10min for 30min, 1 & 4 hr after infusion starts, every 4 hrs, prior to end of infusion & extubation. Follow-up Period (48hrs): every 10min for 1st 30min after drug discontinuation, 1, 4, 8,12, 24 & 48 hr post infusion ] [ Designated as safety issue: No ]

RASS Range:

Score +1 (Restless: Anxious; but movements not aggressive or vigorous) Score 0 (Alert and calm) Score -1 (Drowsy: Not fully alert, but has sustained awakening [eye opening/eye contact] to voice [≥10 seconds]) Score -2 (Light sedation: Briefly awakens with eye contact to voice [< 10 seconds])

The percentage of time spent within the protocol specified sedation range during the study drug administration period.
Complete list of historical versions of study NCT00216190 on ClinicalTrials.gov Archive Site
  • Percentage of subjects able to achieve a RASS between - 2 and +1 without interruption of study drug [ Time Frame: Preinfusion, Treatment period: every 10min for 30min, 1 & 4 hr after infusion starts, every 4 hrs, prior to end of infusion & extubation. Follow-up Period (48hrs): every 10min for 1st 30min after drug discontinuation, 1, 4, 8,12, 24 & 48 hr post infusion ] [ Designated as safety issue: No ]
  • Percentage of subjects with evidence of delirium (Confusion Assessment Method [CAM]-ICU positive) while on study drug [ Time Frame: Prior to the start of the study drug infusion. Daily each morning beginning the day after starting study drug, and at the end of study drug infusion. ] [ Designated as safety issue: No ]
  • Percentage of subjects with evidence of delirium (CAM-ICU positive) following discontinuation of study drug [ Time Frame: At 12, 24, 36, and 48 hrs after end of infusion. Every 12 hours during the 48-hour Follow-Up Period. ] [ Designated as safety issue: No ]
  • Time to achieving a RASS between -2 and +1 for daily arousal assessment [ Time Frame: Prior to the start of the study drug infusion. Daily each morning beginning the day after starting study drug, and at the end of study drug infusion. ] [ Designated as safety issue: No ]
  • Percentage of subjects who can interact with caregivers [ Time Frame: Prior to start of infusion (Day 0), daily each morning throughout the Treatment Period beginning on the day after randomization (Study Day 1), and immediately prior to discontinuation of study drug infusion at the end of Treatment Period. ] [ Designated as safety issue: No ]
    Percentage of subjects who can interact with caregivers (i.e., follow at least 3 of the 4 arousal assessment commands) while in the protocol-specified RASS range of -2 to +1
  • Overall drug (sedative) tolerance [ Time Frame: During the treatment period (Approximately 30 days) ] [ Designated as safety issue: No ]
  • Fentanyl use [ Time Frame: During the treatment period (Approximately 30 days) ] [ Designated as safety issue: No ]
  • Nursing assessment [ Time Frame: Screening period, during the treatment period (Approximately 30 days), and 48-hours of follow-up period ] [ Designated as safety issue: No ]
  • Use of rescue midazolam for sedation [ Time Frame: During the treatment period (Approximately 30 days) ] [ Designated as safety issue: No ]
Number of subjects able to maintain a specified sedation range without study drug interruption; the amount of time required to regain the specified level of sedation; number of subjects displaying delirium characteristics.
Not Provided
Not Provided
 
A Safety and Efficacy Study of Dexmedetomidine in ICU Patients Requiring Continuous Sedation
A Phase 4, Randomized, Double-Blind, Multi-Center, Comparator Study Evaluating the Safety and Efficacy of Dexmedetomidine Compared to IV Midazolam in ICU Subjects Requiring Greater Than Twenty-Four Hours of Continuous Sedation

The purpose of this study is to evaluate the safety and efficacy of dexmedetomidine in ICU subjects who are initially intubated, mechanically ventilated and require sedation for beyond 24 hours.

Traditional agents such benzodiazepines and propofol have long been used to sedate critically ill patients. Unfortunately, these agents have serious disadvantages that may have a negative impact on patient outcomes. These disadvantages include respiratory depression, prolonged mechanical ventilation, paradoxical agitation, myocardial depression, hypotension, tachyphylaxis, physical dependence, and an unpredictable duration of action following long term infusions. Additionally, concomitant use of an opioid or other analgesic is often required for ICU patients to achieve adequate levels of pain relief, which may also prolong awakening and possibly increase respiratory depression.

Dexmedetomidine may offer a new treatment option that remedies many of the deficiencies of traditional sedatives. This agent would provide for accurate, titratable sedation and analgesia without the concurrent respiratory depression and accumulation common to other agents. It may permit greater patient interaction due to reduced impairment of cognition and may reduce risks associated with opioids due to its analgesia sparing property. Although such a drug may have important benefits for ICU patients requiring sedation for greater than 24 hours, dexmedetomidine is not currently approved for such long-term usage.

Interventional
Phase 4
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Mechanically Ventilated and Intubated Subjects
  • Drug: Dexmedetomidine HCL Injection
  • Drug: Midazolam Injection
  • Experimental: Dexmedetomidine
    Intervention: Drug: Dexmedetomidine HCL Injection
  • Active Comparator: Midazolam
    Intervention: Drug: Midazolam Injection
Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009 Feb 4;301(5):489-99. doi: 10.1001/jama.2009.56. Epub 2009 Feb 2.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
420
August 2007
Not Provided

Inclusion Criteria:

  1. Subject is ≥18 years of age.
  2. If female, subject is non-lactating, and is either:

    1. Not of childbearing potential, defined as postmenopausal for at least 1 year or surgically sterile due to bilateral tubal ligation, bilateral oophorectomy, or hysterectomy.
    2. Of childbearing potential but is not pregnant as confirmed by negative serum pregnancy test at time of screening, and is practicing one of the following methods of birth control: oral or parenteral contraceptives for three months prior to study drug administration, a vasectomized partner, or abstinence from sexual intercourse.
  3. Subject is initially intubated and mechanically ventilated, or is planned for imminent intubation and mechanical ventilation, sedation is anticipated to be required during mechanical ventilation, and mechanical ventilation is anticipated to continue for at least 72 hours.
  4. Subject or subject's legally authorized representative has voluntarily signed and dated an informed consent form, approved by the applicable Institutional Review Board (IRB), after the nature of the study has been explained and the subject or subject's legally authorized representative has had the opportunity to ask questions. The informed consent must be signed before any study specific procedures are performed.
  5. Subject is sedated within a Richmond Agitation-Sedation Scale (RASS) range of -2 to +1 at the time of initiation of study drug

Exclusion Criteria:

  1. Subject has been intubated for greater than 96 hours prior to the initiation of study drug (thus, the attainment of consent, screening evaluations, and randomization must all have been completed by the 96th hour post-intubation, so that the actual initiation of the study drug infusion may start by the end of the 96 hour window).
  2. Subject has serious central nervous system pathology/trauma that, per clinical judgment of the Investigator, precludes responsiveness or survival.
  3. Subject for whom opiates, benzodiazepines, or dexmedetomidine are contraindicated, or who has known or suspected serious allergy to any drug that might be administered during the course of the study.
  4. Subject for whom alpha-2 agonists are contraindicated.
  5. Subject requires neuromuscular blocking agents during the study for use other than intubation.
  6. Subject requires epidural or spinal analgesia during the study.
  7. Subject meets any of the following cardiovascular criteria:

    • Acute unstable angina (defined during current hospital stay).
    • Suspicion of acute myocardial infarction.
    • Considered to have a left ventricular ejection fraction of less than 30%. Decision to exclude is predicated on the Investigator's opinion, and may be based on any combination of acute presentations, recently performed diagnostic studies, or a history that suggests poor cardiac function. Pulmonary congestion of a non-cardiac origin or mild congestive failure primarily attributable to etiologies other than poor ventricular function are not exclusion criteria.
    • Heart rate <50 bpm prior to infusion start.
    • Systolic blood pressure <90 mmHg prior to infusion start.
    • Conduction abnormalities except 1st degree AV block and rate-controlled atrial fibrillation; subjects with functional pacemaker capacity may be enrolled.
  8. Subject is hospitalized primarily due to trauma and/or burns, has received general anaesthesia within the 24 hours prior to the start of study drug infusion, or is anticipated to require general anaesthesia within 24 hours after the start of the infusion.
  9. Subject has participated in a trial with any experimental drug within 30 days prior to enrollment in the study, or has ever been enrolled in this study.
  10. Subject is unable to undergo any procedure required by the protocol.
  11. Subject has laboratory results indicating the presence of liver disease consistent with a Child-Pugh score >9 (Grade C).
  12. Subject has acute hepatitis, history or presence of chronic hepatitis, and/or has had a positive result for Hepatitis B Surface Antigen Test.
  13. Subject requires dialysis (eg, hemodialysis, peritoneal dialysis, Continuous Venovenous Hemodialysis [CVVHD]).
  14. Subject has a known, uncontrolled seizure disorder.
  15. Subject has, per the Investigator's judgment, a known or suspected physical or psychological dependence on an abused drug, other than alcohol.
  16. Subject has a known psychiatric illness that could confound a normal response to sedative treatment.
  17. Subject is incarcerated.
  18. Subject is terminally ill with a life duration expectancy of ≤60 days.
  19. Subject has any other condition or factor which, in the Investigator's opinion, might increase the risk to the subject.
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States,   Argentina,   Australia,   Brazil,   New Zealand
 
NCT00216190
2001-001
No
Hospira, Inc.
Hospira, Inc.
Not Provided
Not Provided
Hospira, Inc.
July 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP