Fluid Resuscitation in Early Septic Shock (PRECISE)

This study has been completed.
Sponsor:
Collaborators:
Canadian Blood Services
Baxter Healthcare Corporation
Information provided by:
Ottawa Hospital Research Institute
ClinicalTrials.gov Identifier:
NCT00819416
First received: January 8, 2009
Last updated: April 13, 2010
Last verified: April 2010
  Purpose

Severe infection in the intensive care unit is common accounting for about 10% of admissions and has a death rate of approximately 40-50%. It is almost always associated with significant reductions in blood pressure. Administration of fluid often in large volumes is essential to normalize blood pressure and prevent failure of organs and death. Two common classes of fluid solutions are crystalloid fluids (salt based, normal saline) and colloid fluids (protein based, albumin). Due to its properties, the albumin fluid may remain in the vascular space better than the normal saline solution. Hence, there may be faster attainment of normal blood pressure as well as a reduction in failed organs and death. Preliminary clinical trial data suggests a potential for benefit with albumin in this setting but these findings require confirmation in a large clinical trial.

There are few data to explain how albumin may exert its protective effects and lead to better outcomes for patients with severe infections. We will conduct a clinical study that will examine potential biological mechanisms for albumin's protective effects in 50 patients across 6 Canadian academic hospitals. We will also examine our ability to successfully recruit patients into this trial.

This study will provide information that will help to understand the biological mechanisms of albumin in severe infection. The information gained will guide the investigative team for future fluid related mechanistic questions. The study will also provide essential information that will aid in the design and conduct of the future large clinical trial that will examine death as its primary outcome.


Condition Intervention Phase
Septic Shock
Sepsis
Severe Sepsis
Drug: 5% albumin
Drug: Normal Saline
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Pharmacodynamics Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Five Percent Albumin Versus Normal Saline as Fluid Resuscitation Strategies for the Management of Early Suspected Septic Shock

Resource links provided by NLM:


Further study details as provided by Ottawa Hospital Research Institute:

Primary Outcome Measures:
  • Comparison of thrombin generation and protein C and APC levels [ Time Frame: Thrombin generation at 72 hours and protein C and APC levels at 7 days after randomization ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Comparison of blood and urine pro and anti-inflammatory cytokine and chemokine levels.Clinical outcomes include mortality, length of stay,organ failure, and organ support measures. [ Time Frame: Inflammatory markers measured first 7 days of care. Mortality in ICU/hospital/30 days. Length of stay ICU/hospital. Organ failure first 7 days of care. ] [ Designated as safety issue: No ]

Enrollment: 47
Study Start Date: February 2009
Study Completion Date: February 2010
Primary Completion Date: October 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
5% albumin
Drug: 5% albumin
5% albumin for the first 7 days of care in the ICU
Other Name: colloid fluid
2
Normal saline
Drug: Normal Saline
Normal Saline for the first 7 days of care in the ICU
Other Name: crystalloid fluid

  Show Detailed Description

  Eligibility

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

Inclusion Criteria:

Eligible patients will meet the following 2 inclusion criteria.

  1. Refractory Hypotension: The patient has received at least 1 litre of normal saline or ringers lactate crystalloid fluid for hypotension (defined as a systolic blood pressure less than 90 mm Hg, or a systolic blood pressure more than 40 mm Hg below baseline, or a mean arterial blood pressure less than 65 mm Hg) within 8 hours of the first hypotensive event and has refractory hypotension defined by: a) Presence of hypotension OR b) Initiation of a vasopressor agent(s).
  2. Two or more criteria for the systemic inflammatory response syndrome (SIRS): i) heart rate greater than 90 beats per minute; ii) respiratory rate greater than 20 breathes per minute, or a PaC02 less than 32 mm Hg, or mechanically ventilated; iii) temperature greater than 38 or less than 36 degrees Celsius; iv) or a white blood cell count greater than 12,000 x 109/L or less than 4,000 x 109/L, or more than 10% bands on the differential.

Exclusion Criteria:

  1. Clinically apparent other forms of shock including cardiogenic, obstructive (massive pulmonary embolism, cardiac tamponade, tension pneumothorax) or hemorrhagic shock
  2. Previous admission to ICU with severe sepsis or septic shock during the index hospitalization
  3. More than 250 mls of colloid fluid (Pentaspan, Voluven, Hextend, or albumin) from the first episode of hypotension
  4. A known previous severe reaction to albumin
  5. Burns
  6. Known cirrhosis
  7. Traumatic brain injury
  8. Religious objection to albumin use
  9. Less than 18 years of age
  10. Pregnant
  11. Family or patient not committed to aggressive care
  12. Currently enrolled in another related interventional study.
  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: NCT00819416

Locations
Canada, Alberta
University of Alberta Hospital
Edmonton, Alberta, Canada, T6G 2B7
Canada, Manitoba
Winnipeg Health Sciences Center
Winnipeg, Manitoba, Canada, R3P 0X1
Canada, Nova Scotia
Halifax Capital Health Center
Halifax, Nova Scotia, Canada, B3H 2Y9
Canada, Ontario
Hamilton General Hospital
Hamilton, Ontario, Canada, L8N 3Z5
Ottawa Hospital Research Institute
Ottawa, Ontario, Canada, K1H 8L6
Canada, Quebec
Hôpital de l'Enfant-Jésus
Quebec City, Quebec, Canada, G1J 1Z4
Sponsors and Collaborators
Ottawa Hospital Research Institute
Canadian Blood Services
Baxter Healthcare Corporation
Investigators
Principal Investigator: Lauralyn A McIntyre, MD Ottawa Hospital Research Institute
Principal Investigator: Alan Tinmouth, MD Ottawa Hospital Research Institute
Principal Investigator: Alison Fox Robichaud, MD Hamilton Health Sciences Corporation
  More Information

No publications provided

Responsible Party: Lauralyn McIntyre MD, FRCPC, MHSc, Ottawa Hospital Research Institute
ClinicalTrials.gov Identifier: NCT00819416     History of Changes
Other Study ID Numbers: 2008640
Study First Received: January 8, 2009
Last Updated: April 13, 2010
Health Authority: Canada: Ethics Review Committee

Keywords provided by Ottawa Hospital Research Institute:
randomized controlled trial
clinical trial

Additional relevant MeSH terms:
Sepsis
Shock
Shock, Septic
Infection
Inflammation
Pathologic Processes
Systemic Inflammatory Response Syndrome

ClinicalTrials.gov processed this record on October 22, 2014