SEvoflurane for Sedation in ARds

  • STATUS
    Recruiting
  • End date
    Dec 31, 2024
  • participants needed
    700
  • sponsor
    University Hospital, Clermont-Ferrand
Updated on 29 October 2021
edema
heart failure
fluid overload
acute respiratory distress
FIO2
respiratory failure
pao2
positive end expiratory pressure
respiratory symptoms
shock
atelectasis
respiratory symptom
effusions
sevoflurane

Summary

This study evaluates whether a sedation with inhaled sevoflurane will decrease mortality and increase time off the ventilator at 28 days in patients with acute respiratory distress syndrome (ARDS).

Half of the patients will receive inhaled sedation with sevoflurane and the other half will receive intravenous sedation with propofol.

Description

PRIMARY OBJECTIVE:

To assess the efficacy of a sedation with inhaled sevoflurane in improving in reducing mortality and morbidity in patients with moderate-severe ARDS in comparison to a control group receiving intravenous sedation with propofol.

PRIMAY HYPOTHESIS:

Inhaled sedation with sevoflurane will improve a composite outcome of mortality and time off the ventilator at 28 days, in patients with moderate-severe ARDS.

The trial will accrue a maximum of 700 patients. Patients will be recruited from participating intensive care units and randomized to the active (inhaled sevoflurane) or control (intravenous propofol).

The overall strategy is to screen and enroll early, every newly intubated, acutely ill or postoperative, patient at each site, using clinically obtained pulse oximetry and blood gases.

By providing superior awakening and extubation times, as well as lung-protective effects from anti-inflammatory and protective effects from epithelial injury, inhaled sevoflurane may hasten recovery from lung injury and improve outcomes.

Details
Condition Pulmonary Disease, ADULT RESPIRATORY DISTRESS SYNDROME, Acute Respiratory Distress Syndrome (ARDS), Acute Respiratory Distress, Lung Disease, acute respiratory distress syndrome, ards
Treatment Inhaled sedation with sevoflurane, intravenous sedation with propofol
Clinical Study IdentifierNCT04235608
SponsorUniversity Hospital, Clermont-Ferrand
Last Modified on29 October 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Age 18 years
Presence for 24 hours of all of the following conditions, within one week of a clinical insult or new or worsening respiratory symptoms
PaO2/FiO2 <150 mmHg with positive end-expiratory pressure (PEEP) 8 cmH2O (or, if arterial blood gas not available, SpO2/FiO2 that is equivalent to a PaO2/FiO2 <150 mmHg with PEEP 8 cmH2O and a confirmatory SpO2/FiO2 between 1-6 hours after the initial SpO2/FiO2 determination)
Bilateral opacities not fully explained by effusions, lobar/lung collapse, or nodules
Respiratory failure not fully explained by cardiac failure or fluid overload; need objective assessment (e.g., echocardiography) to exclude hydrostatic edema if no risk factor present

Exclusion Criteria

Absence of affiliation to the French Sociale security
Patient under a tutelage measure or placed under judicial protection
Continuous sedation with inhaled sevoflurane at enrollment
Known pregnancy
Currently receiving ECMO therapy
Chronic respiratory failure defined as PaCO2 >60 mmHg in the outpatient setting
Home mechanical ventilation (non-invasive ventilation or via tracheotomy) except for CPAP/BIPAP used solely for sleep-disordered breathing
Body mass index >40 kg/m2
Chronic liver disease defined as a Child-Pugh score of 12-15
Expected duration of mechanical ventilation <48 hours
Moribund patient, i.e. not expected to survive 24 hours despite intensive care
Burns >70% total body surface
Previous hypersensitivity or anaphylactic reaction to sevoflurane or cisatracurium
Medical history of malignant hyperthermia
Long QT syndrome at risk of arrhythmic events
Medical history of liver disease attributed to previous exposure to a halogenated agent (including sevoflurane)
Known hypersensitivity to propofol or any of its components
Known allergy to eggs, egg products, soybeans, and soy products
Suspected or proven intracranial hypertension
Tidal volume of 6 mL/kg predicted body weight (PBW) below 200 mL (as recommended by the manufacturer for the use of the AnaConDa-S (Sedana Medical, Danderyd, Sweden)
Enrollment in another interventional ARDS trial with direct impact on sedation and mechanical ventilation
Endotracheal ventilation for greater than 120 hours (5 days)
Persistent bronchopleural fistula despite chest tube drainage
PaO2/FiO2 (if available) >200 mmHg after meeting inclusion criteria and before randomization
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