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ICU Patients Requiring Invasive Mechanical VentilationAWARENCT01617265

Study of a Strategy to Prevent Oversedation in Intensive Care Patients Under Mechanical Ventilation

A study testing Clinical Procedure to Prevent Oversedation and Usual sedation practice in people with ICU Patients Requiring Invasive Mechanical Ventilation, run by French Society for Intensive Care at 43 sites in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of the present study is to determine whether administration of sedation according to a strategy including a bundle of measures to prevent oversedation is associated with a reduction in mortality of intensive care unit patients requiring mechanical ventilation, compared to administration of sedation… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Clinical Procedure to Prevent Oversedation and Usual sedation practice
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,180 participants
Where
43 sitesFrance
Study dates
Jun 2012to Jun 2015
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 and older
  • Admission to ICU with expected mechanical ventilation duration > 48 hrs
  • Mechanical ventilation in ICU for less than 12 hours
  • Information provided to the patient or proxy

Who cannot join

  • ICU Admission after cardiac arrest
  • Acute or chronic neuromuscular disease
  • Tracheotomy on ICU admission
  • Acute cerebral injury with intracranial hypertension requiring continuous IV sedation with or without neuromuscular blockade
  • Status epilepticus
  • Treatment withdrawal decision
  • Pregnancy, breast feeding
  • Concurrent participation in another interventional study requiring a change in usual practice of sedation or mechanical ventilation

Trial locations and contacts

43 sites in 1 country.

43 sites in 1 country

France43 sites
  • Hôpital Saint-Esprit

    Agen, 47923

  • CHU d'Angers

    Angers, 49000

  • Hopital Privé d'Antony

    Antony, 92166

  • CH d'Argenteuil

    Argenteuil, 95100

  • CH Germon et Gauthier

    Beuvry, 62408

  • Hopital Avicenne

    Bobigny, 93000

  • Hopital St-Andre

    Bordeaux, 33075

  • Hopital Ambroise Pare

    Boulogne-Billancourt, 92100

  • CHRU de la Cavale Blanche

    Brest, 29609

  • Hopital Antoine Beclere

    Clamart, 92140

  • CH Sud Francilien

    Corbeil-Essones, 91106

  • CHU Henri Mondor

    Créteil, 94010

  • Hopital Raymond Poincare

    Garches, 92380

  • CHD Les Oudairies

    La Roche-sur-Yon, 85925

  • CH de Versailles

    Le Chesnay, 78157

  • CHU Kremlin-Bicetre

    Le Kremelin-Bicetre, 94270

  • Hopital Roger Salengro

    Lille, 59037

  • CH St-Joseph St-Luc

    Lyon, 69000

  • Groupe Hospitalier Edouard Herriot

    Lyon, 69437

  • CHU Marseille Hopital Nord

    Marseille, 13015

  • Hopital de la Timone

    Marseille, 13385

  • CH de Meaux

    Meaux, 77104

  • Hopital Notre-Dame de Bon Secours

    Metz, 57038

  • CH Princesse Grace

    Monaco, 98012

  • GHIRM

    Montfermeil, 93370

  • Hopital Laennec

    Nantes, 44035

  • Hopital l'Archet

    Nice, 06202

  • CHR d'Orléans Hopital la Source

    Orléans, 45067

  • Hopital St Louis

    Paris, 75010

  • Institut Mutualiste Montsouris

    Paris, 75014

  • Hopital Tenon

    Paris, 75020

  • CH Francois Miterrand

    Pau, 64046

  • CH Poissy

    Poissy, 78300

  • CH de Pontoise

    Pontoise, 95303

  • CH de la Région d'Annecy

    Pringy, 74374

  • CH Leon Binet

    Provins, 77488

  • CH de St-Brieuc

    Saint-Brieuc, 22027

  • Hopital Delafontaine

    Saint-Denis, 93200

  • HIA Béjin

    Saint-Mandé, 94160

  • CH de St-Malo

    St-Malo, 35403

  • CHRU Bretonneau

    Tours, 37044

  • Hopital Jean Bernard

    Valenciennes, 59322

  • Institut Gustave Roussy

    Villejuif, 94805

Other trials in France

About this study

Official title: Prevention of Oversedation in Intensive Care Patients Under Mechanical Ventilation : the AWARE Multicentric Randomized Trial

The purpose of the present study is to determine whether administration of sedation according to a strategy including a bundle of measures to prevent oversedation is associated with a reduction in mortality of intensive care unit patients requiring mechanical ventilation, compared to administration of sedation according to usual practices.

Read the detailed description

In intensive care unit (ICU) patients receiving mechanical ventilation (MV), potent hypnotics and morphinics are frequently administered to increase synchrony with the ventilator, control agitation and decrease discomfort and pain due to the tracheal tube, bed ridding, painful condition and diagnostic or therapeutic procedures.

However, administration sedatives or morphinics is often excessive and may result in deep and prolonged alteration of consciousness, delayed weaning from MV and prolonged MV. and exposes the patient to a higher risk of ventilator-associated pneumonia, ICU delirium and neuromuscular weakness at awakening.

The present randomized multicenter study will compare the day-90 mortality of a group of patients receiving conventional sedation to the mortality of a group of patients receiving sedation administered according to an algorithm aimed to prevent oversedation to the mortality. The algorithm is built on a graduate therapeutic response to increasingly intense symptoms of discomfort, pain, ventilator dyssynchrony and agitation, and includes the use of analgesics, non hypnotic benzodiazepines, neuroleptics, repeated intravenous (IV) boluses of hypnotics and short duration (6 hours) IV hypnotic infusions.

Being tested
Clinical Procedure to Prevent Oversedation, Usual sedation practice
Keywords
intensive care, mechanical ventilation, sedatives, morphinics, oversedation, mortality, midazolam, propofol, pain, agitation
Medical subject headings
Pain, Psychomotor Agitation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Clinical Procedure to Prevent OversedationProcedure or surgery

    Sedation and analgesia will be administered according to a bundle of measures aimed at limiting oversedation, including repeated assessment of patients needs and graduate therapeutic response to control pain, discomfort, poor synchrony with the ventilator and agitation. The therapeutic options include non hypnotic anxiolytics, repeated IV hypnotics boluses, short-duration (6 hours) IV hypnotics infusion and round the clock IV hypnotics infusion.

  • Usual sedation practiceProcedure or surgery

    Sedation and analgesia will be administered according to the usual practices in each participating center.

Study groups in NCT01617265
Study groupRoleWhat they receive
Prevention of oversedation groupExperimentalIn this arm sedation and analgesia will be administered according to a bundle of measures aimed at limiting oversedation, including repeated assessment of patients needs and graduate therapeutic response to control pain, discomfort, poor synchrony with the ventilator and agitation. The therapeutic options include non hypnotic anxiolytics, repeated intravenous (IV) hypnotics boluses, short-duration (6 hours) IV hypnotics infusion and round the clock IV hypnotics infusion.
Receives: Procedure: Clinical Procedure to Prevent Oversedation
Conventional sedation groupActive comparatorIn this arm, sedation will be administered according to the usual practices in each participating center.
Receives: Procedure: Usual sedation practice

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Day-90 mortality

    Measured: Mortality at Day 90 after randomization

Secondary outcomes (14)
  1. Mortality at Day 28

    Measured: at day 28

  2. Hospital mortality

    Measured: at hospital discharge, up to day 90

  3. 1-yr mortality

    Measured: at 1 yr

  4. Mechanical ventilation duration

    Measured: From onset of mechanical ventilation to day 28

  5. Days alive with no mechanical ventilation

    Measured: From ICU admission up to day 28

  6. Occurence of ventilator-associated pneumonia

    Measured: During mechanical ventilation duration, up to day 28

  7. Use of non-invasive ventilation after extubation

    Measured: From extubation to ICU discharge up to day 28

  8. Duration of ICU stay

    Measured: From ICU admission to ICU discharge or death in ICU, up to day 90

  9. ICU confusion

    Number of patients alive, awaken, and free of ICU-delirium assessed on the CAM-ICU

    Measured: From Day 1 to 7, and at day 14, 21 and 28

  10. Proximal muscle weakness

    Number of patients alive, awaken, cooperative and free of proximal muscle weakness

    Measured: from day 1 to 7, and at day 14, 21 and 28

  11. Functional, cognitive and psychological status

    Functional status (measured on the Barthel scale), depression (measured on the Hospital Anxiety \& Depression Scale), Posttraumatic stress disorder (measured on the Impact of Event Scale), Quality of Life (measured on the SF-36) and patient living location

    Measured: At day 90 and 1 year

  12. Time to weaning onset

    Measured: Time from mechancial ventilation initiation to first spontaneous breathing trial, up to day 28

  13. Number of patients requiring tracheotomy

    Measured: During ICU stay, up to day 28

  14. First sitting in chair

    Measured: During ICU stay, up to day 28

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Jun 2012 (estimated)
  2. Study startJun 2012
  3. Primary completionJun 2015
  4. Study completionJun 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,180 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01617265
Sponsor's protocol ID
SRLF-TG-1-AWARE
Other IDs
2011-004246-18
Acronym
AWARE
Status last verified
Aug 2015
First submitted
6 Jun 2012
Last updated
26 Aug 2015
Results posted
No
Data monitoring committee
Yes

Publications

  • Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, Binhas M, Genty C, Rolland C, Bosson JL. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007 Apr;106(4):687-95; quiz 891-2. doi: 10.1097/01.anes.0000264747.09017.da.

    PubMed 17413906
  • Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest. 1998 Aug;114(2):541-8. doi: 10.1378/chest.114.2.541.

    PubMed 9726743
  • Constantin JM, Chanques G, De Jonghe B, Sanchez P, Mantz J, Payen JF, Sztark F, Richebe P, Lagneau F, Capdevila X, Bazin JE, Lefrant JY. [Current use of sedation and analgesia: 218 resuscitations in France services practices survey]. Ann Fr Anesth Reanim. 2010 May;29(5):339-46. doi: 10.1016/j.annfar.2010.01.014. Epub 2010 Apr 13. French.

    PubMed 20392591
  • Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med. 1999 Dec;27(12):2609-15. doi: 10.1097/00003246-199912000-00001.

    PubMed 10628598
  • De Jonghe B, Bastuji-Garin S, Fangio P, Lacherade JC, Jabot J, Appere-De-Vecchi C, Rocha N, Outin H. Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med. 2005 Jan;33(1):120-7. doi: 10.1097/01.ccm.0000150268.04228.68.

    PubMed 15644658
  • Quenot JP, Ladoire S, Devoucoux F, Doise JM, Cailliod R, Cunin N, Aube H, Blettery B, Charles PE. Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med. 2007 Sep;35(9):2031-6. doi: 10.1097/01.ccm.0000282733.83089.4d.

    PubMed 17855817
  • Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000 May 18;342(20):1471-7. doi: 10.1056/NEJM200005183422002.

    PubMed 10816184
  • Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010 Feb 6;375(9713):475-80. doi: 10.1016/S0140-6736(09)62072-9. Epub 2010 Jan 29.

    PubMed 20116842
  • Treggiari MM, Romand JA, Yanez ND, Deem SA, Goldberg J, Hudson L, Heidegger CP, Weiss NS. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009 Sep;37(9):2527-34. doi: 10.1097/CCM.0b013e3181a5689f.

    PubMed 19602975
  • Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004 Apr 14;291(14):1753-62. doi: 10.1001/jama.291.14.1753.

    PubMed 15082703
  • SRLF Trial Group. Impact of oversedation prevention in ventilated critically ill patients: a randomized trial-the AWARE study. Ann Intensive Care. 2018 Sep 21;8(1):93. doi: 10.1186/s13613-018-0425-3.

    PubMed 30242747

Questions about this trial

What is this clinical trial studying?

A study testing Clinical Procedure to Prevent Oversedation and Usual sedation practice in people with ICU Patients Requiring Invasive Mechanical Ventilation, run by French Society for Intensive Care at 43 sites in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Aug 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 43 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Day-90 mortality (time frame: Mortality at Day 90 after randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01617265, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Aug 2015.

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