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
  Purpose

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.


Condition Intervention Phase
Mechanically Ventilated and Intubated Subjects
Drug: Dexmedetomidine HCL Injection
Drug: Midazolam Injection
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: 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

Resource links provided by NLM:


Further study details as provided by Hospira, Inc.:

Primary Outcome Measures:
  • 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])



Secondary Outcome Measures:
  • 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 ]

Enrollment: 420
Study Start Date: March 2005
Study Completion Date: August 2007
Arms Assigned Interventions
Experimental: Dexmedetomidine Drug: Dexmedetomidine HCL Injection
Active Comparator: Midazolam Drug: Midazolam Injection

Detailed Description:

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.

  Eligibility

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

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.
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00216190

  Hide Study Locations
Locations
United States, Alabama
Birmingham, Alabama, United States, 35294
United States, Arizona
Chandler, Arizona, United States, 85248
Phoenix, Arizona, United States
Scottsdale, Arizona, United States, 85258
United States, Arkansas
Rogers, Arkansas, United States, 72756
United States, California
Davis, California, United States, 95616
Loma Linda, California, United States, 92354
Palo Alto, California, United States, 94304
Pasadena, California, United States, 91105
Redlands, California, United States, 92373
Sacramento, California, United States, 95819
San Clemente, California, United States, 92672
San Francisco, California, United States
San Jose, California, United States
United States, Colorado
Denver, Colorado, United States, 80204
United States, Connecticut
Farmington, Connecticut, United States, 06030
New Haven, Connecticut, United States, 06520
United States, Delaware
Newark, Delaware, United States, 19718
United States, District of Columbia
Washington, District of Columbia, United States, 20010
United States, Florida
Bay Pines, Florida, United States, 33744
Miami, Florida, United States
Orlando, Florida, United States, 32804
Tampa, Florida, United States, 33606
United States, Georgia
Atlanta, Georgia, United States
Augusta, Georgia, United States, 30909
Gordon, Georgia, United States, 30905
United States, Illinois
Arlington Heights, Illinois, United States, 60005
Oak Park, Illinois, United States, 60302
Peoria, Illinois, United States, 61603
United States, Indiana
Indianapolis, Indiana, United States
United States, Iowa
Iowa City, Iowa, United States, 52242
United States, Kansas
Kansas City, Kansas, United States, 66160
Olathe, Kansas, United States, 66061
United States, Kentucky
Hazard, Kentucky, United States, 41701
Louisville, Kentucky, United States
United States, Louisiana
Alexandria, Louisiana, United States, 71301
Shreveport, Louisiana, United States
United States, Maine
Biddeford, Maine, United States, 04005
Portland, Maine, United States
United States, Maryland
Baltimore, Maryland, United States, 21201
United States, Massachusetts
Boston, Massachusetts, United States, 02115
United States, Michigan
Flint, Michigan, United States, 48532
United States, Montana
Missoula, Montana, United States
United States, Nebraska
Omaha, Nebraska, United States, 68131
United States, New Jersey
Camden, New Jersey, United States, 08103
Englewood, New Jersey, United States, 07631
United States, New York
Bronx, New York, United States
Brooklyn, New York, United States, 11215
Buffalo, New York, United States, 14215
Mineola, New York, United States, 11501
New York, New York, United States, 10011
Rochester, New York, United States, 14642
Stoney Brook, New York, United States, 11794
Syracuse, New York, United States, 13210
United States, North Carolina
Chapel Hill, North Carolina, United States, 27599
Charlotte, North Carolina, United States, 28207
Greensboro, North Carolina, United States
Winston-Salem, North Carolina, United States
United States, Ohio
Akron, Ohio, United States, 44307
Dayton, Ohio, United States, 45429
Kettering, Ohio, United States, 45429
Toledo, Ohio, United States
United States, Oklahoma
Olkahoma City, Oklahoma, United States, 73104
United States, Oregon
Medford, Oregon, United States, 97504
United States, Pennsylvania
Danville, Pennsylvania, United States, 17882
Monroeville, Pennsylvania, United States, 15146
Pittsburgh, Pennsylvania, United States, 15219
United States, South Carolina
Charleston, South Carolina, United States, 29425
Spartanburg, South Carolina, United States, 29303
United States, Tennessee
Memphis, Tennessee, United States, 38163
United States, Texas
Dallas, Texas, United States
Galveston, Texas, United States, 77555
Houston, Texas, United States, 77024
Lubbock, Texas, United States, 79430
United States, Utah
Ogden, Utah, United States, 84403
United States, Virginia
Lynchburg, Virginia, United States, 24501
United States, West Virginia
Morgantown, West Virginia, United States, 26505
United States, Wisconsin
Madison, Wisconsin, United States, 53792
Argentina
Ciudad de Buenos Aires, Argentina
Australia, New South Wales
Blacktown, New South Wales, Australia, 2148
Randwick, New South Wales, Australia, 2031
Australia, South Australia
Woodville, South Australia, Australia, 5011
Australia, Tasmania
Hobart, Tasmania, Australia, 7001
Australia, Victoria
Box Hill, Victoria, Australia, 3128
Heidelberg, Victoria, Australia, 3084
Parkville, Victoria, Australia, 3050
Australia, Western Australia
Perth, Western Australia, Australia, 6000
Brazil
Porto Alegre, RS, Brazil, 90610-000
Porto Alegre, RS, Brazil, 90020-090
Pedro de Toledo, San Paulo, Brazil, 04039-901
Santo Andre, San Paulo, Brazil, 09190-610
Sao Paulo, SP, Brazil, 01323-001
New Zealand
Christchurch, New Zealand, 8001
Hastings, New Zealand, 4201
Palmerston North, New Zealand, 5301
Welling, New Zealand, 6002
Sponsors and Collaborators
Hospira, Inc.
  More Information

No publications provided by Hospira, Inc.

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Hospira, Inc.
ClinicalTrials.gov Identifier: NCT00216190     History of Changes
Other Study ID Numbers: 2001-001
Study First Received: August 31, 2005
Last Updated: July 22, 2015
Health Authority: United States: Food and Drug Administration

Keywords provided by Hospira, Inc.:
Sedation, ICU, Anesthesia, Dexmedetomidine, Midazolam

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

ClinicalTrials.gov processed this record on July 30, 2015