Beta-blocker Before Extubation

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00563238
Recruitment Status : Withdrawn
First Posted : November 26, 2007
Last Update Posted : February 28, 2017
Information provided by (Responsible Party):
Gregory A. Schmidt, University of Iowa

November 21, 2007
November 26, 2007
February 28, 2017
November 2007
December 2009   (Final data collection date for primary outcome measure)
The rate of ischemia as judged by ST segment analysis in the 4h following extubation [ Time Frame: 4 hours ]
Same as current
Complete list of historical versions of study NCT00563238 on Archive Site
  • Rate-pressure product following extubation [ Time Frame: 30min, 2h, 4h ]
  • Troponin T elevations, the incidence of cardiogenic edema, and the rate of reintubation [ Time Frame: 48h ]
  • Pro-BNP levels [ Time Frame: 30min ]
Same as current
Not Provided
Not Provided
Beta-blocker Before Extubation
Use of Prophylactic Beta Blockade to Prevent Peri-extubation Cardiac Ischemia and Congestive Heart Failure
Silent myocardial ischemia is known to occur in the general medical intensive care unit population immediately following tracheal extubation. We believe these patients are at risk for primary cardiac events in the 4 hours immediately following extubation. Metoprolol is a selective beta-1 antagonist, with little to no beta-2 activity at low and moderate doses. The cardioprotective effects of beta blockade have been well documented in randomized controlled trials. In patients undergoing extubation, prophylactic use of intravenous metoprolol may reduce post-extubation ischemia events as well as precursors of cardiogenic pulmonary edema (atrial and ventricular wall tension). Our primary hypothesis is that prophylactic metoprolol (titrated to reduce resting heart rate by at least 10%) prior to tracheal extubation will reduce the rate of ischemia as judged by ST segment analysis.
Not Provided
Not Applicable
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Prevention
Myocardial Ischemia
Drug: Metoprolol
Metoprolol administered intravenously in 2.5mg boluses until the resting heart rate falls by 10% from baseline to a maximum dose of 10mg, or until there is any apparent adverse reaction.
  • No Intervention: Control
  • Active Comparator: Metoprolol
    Intervention: Drug: Metoprolol
Not Provided

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
December 2009
December 2009   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Adult medical or cardiac intensive care unit patients on mechanical ventilation who have known coronary artery disease or have at least 2 of the following risk factors for coronary artery disease:

    • Cigarette smoking
    • Hypertension (BP 140/90 or antihypertensive medication)
    • Low HDL-cholesterol (HDL-C) (<40 mg/dL [1.03 mmol/L])
    • Family history of premature CHD (in male first degree relatives <55 years, in female first degree relative <65 years)
    • Age (men 45 years, women 55 years)
    • Diabetes mellitus
    • Symptomatic carotid artery disease
    • Peripheral arterial disease
    • Abdominal aortic aneurysm

Exclusion Criteria:

  • Arterial hypotension, defined as mean arterial pressure < 60 mmHg or requiring any intravenous vasoactive medication.
  • The presence of known reactive airway disease.
  • Resting heart rate of <60 in the period prior to tracheal extubation..
  • The presence of decompensated congestive heart failure, defined as requiring continuous infusion of an inotropic agent.
  • Known hypersensitivity to beta-blockers or any other contraindication to their use.
  • Subjects younger than 18 years of age.
  • Inability to obtain consent from the subject or the subjects authorized representative.
  • Pregnancy
  • Digoxin therapy
  • Current therapy with a beta-blocker
Sexes Eligible for Study: All
18 Years to 99 Years   (Adult, Senior)
Contact information is only displayed when the study is recruiting subjects
United States
Not Provided
Not Provided
Gregory A. Schmidt, University of Iowa
Gregory A. Schmidt
Not Provided
Principal Investigator: Gregory A Schmidt, MD University of Iowa
University of Iowa
February 2017

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