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Critical IllnessNCT02634658

The Diagnosis and Incidence of Critical Illness Polyneuromyopathy in Medical and Neurosurgical ICU Patients

A study testing Muscle Ultrasound, Nerve Conduction Study and Electromyography in people with Critical Illness, run by University of Colorado, Denver at 1 site in United States.

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

This study plans to learn more about whether simpler diagnostic tests can be used to identify the development of acute neuromuscular loss of function in patients with critical illness and respiratory failure receiving mechanical ventilation. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Critical Illness
What is being tested?
Muscle Ultrasound, Nerve Conduction Study and Electromyography
Could I receive a placebo?
No, everyone receives an active treatment
How many people
120 participants
Where
1 siteUnited States
Study dates
Jun 2009to Sep 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

  • For Aim 1.1-1.3, one of the following 2 sets of criteria are needed for inclusion
  • Set 1:
  • Acute respiratory failure defined as a Pa02 < 60 mm Hg on room air, the requirement of supplemental oxygen, or a PaC02 > 45 mm Hg.
  • Admission to an intensive care unit.
  • Mechanical ventilation support through an endotracheal tube for greater than 48 hours.
  • Severe sepsis (suspected or documented infection + at least 2/4 SIRS criteria + organ dysfunction) or septic shock (sepsis plus hypotension refractory to intravenous fluids or plasma lactate > 1.5 times the upper limit of normal)
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  • Set 2:
  • Acute respiratory failure defined as requiring invasive or non-invasive ventilation with a p/f ratio ≤ 250
  • Admission to an intensive care unit, in ICU for greater than 48 hours.
  • Plus dysfunction in one of the following organ systems:
  • Cardiovascular dysfunction: (at least one of the following) i. SBP ≤ 90 mm Hg or MAP ≤ 70 mm Hg for at least one hour despite adequate fluid resuscitation. Adequate fluid resuscitation is defined as the patient receiving intravenous fluid resuscitation of ≥ 30 mL/kg administered at any time during the 4 hours before a hypotensive blood pressure.
  • The use of vasopressors in an attempt to maintain a SBP of ≥ 90 mm Hg or a MAP of ≥ 65 mm Hg despite adequate intravascular volume status. Adequate intravascular volume status is defined as intravenous fluid resuscitation of ≥ 30 mL/kg administered at any time during the 4 hours before or after initiation of vasopressor therapy. Vasopressive therapy is defined as any one of the following: Norepinephrine, Phenylephrine, Epinephrine, Dopamine ≥ 5 mcg/kg/min, or Vasopressin ≥ 0.03 units/min.
  • Kidney dysfunction: Urine output < 0.5 ml/kg of body weight/hr for 1 hour despite adequate fluid resuscitation or adequate intravascular volume status (as defined above)
  • Hematologic dysfunction: Platelet count < 80,000 or a decrease by 50% over the previous 3 days.
  • Acidosis: (at least one of the following) i. pH ≤ 7.30 ii. Plasma lactate > 1.5 times the upper limit of normal
  • For Aim 1.4, all of the following criteria are needed for inclusion.
  • Non-traumatic subarachnoid hemorrhage or intracerebral (intraparenchymal) hemorrhage.
  • Admission to a neurological or neurosurgical intensive care unit.
  • Mechanical ventilation support through an endotracheal tube for greater than 48 hours.

Who cannot join

  • For Aim 1.1-1.3:
  • Age less than 18 years.
  • Diagnosis of pre-existing disease of the peripheral motor or sensory nervous system or myopathy.
  • Central nervous system disorder that would compromise the ability of the patient to participate in the study.
  • Pharmacologic paralysis.
  • Absence of ability to test at least one arm and one leg with NCS/EMG (e.g. due to amputation or overlying equipment).
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  • Decremental response on repetitive nerve stimulation.
  • External pacemaker wire.
  • Pregnancy.
  • Initiation of mechanical ventilation (invasive or non-invasive) and admission to the ICU both >120 hours (5 days) ago.
  • Referral from another hospital for patients that have required mechanical ventilation for more than 48 hours.
  • Inability to obtain informed consent or refusal to participate in the study.
  • Known steroid-induced myopathy prior to ICU admission resulting from chronic systemic glucocorticoid therapy.
  • For Aim 1.4:
  • Isolated subdural or epidural hematoma
  • Age less than 18 years.
  • Diagnosis of pre-existing disease of the peripheral motor or sensory nervous system or myopathy.
  • Pharmacologic paralysis.
  • Absence of ability to test at least one arm and one leg with NCS/EMG (e.g. due to amputation or overlying equipment).
  • Decremental response on repetitive nerve stimulation.
  • External pacemaker wire.
  • Pregnancy.
  • Initiation of mechanical ventilation and admission to the ICU both >120 hours (5 days) ago.
  • Referral from another hospital for patients that have required mechanical ventilation for more than 48 hours.
  • Inability to obtain informed consent or refusal to participate in the study. Known steroid-induced myopathy prior to ICU admission resulting from chronic systemic glucocorticoid therapy.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Colorado Hospital

    Aurora, Colorado, 80045

Other trials in United States

About this study

This study plans to learn more about whether simpler diagnostic tests can be used to identify the development of acute neuromuscular loss of function in patients with critical illness and respiratory failure receiving mechanical ventilation. ICU patients admitted to the University of Colorado Hospital will be screened for eligibility and enrollment in the study to receive weekly measurements of nerve and muscle function through nerve conduction studies (NCS), muscle ultrasound tests, and concentric needle electromyography (EMG) tests.

Read the detailed description

This study plans to learn more about whether simpler diagnostic tests can be used to identify the development of acute neuromuscular loss of function in patients with critical illness and respiratory failure receiving mechanical ventilation. ICU patients admitted to the University of Colorado Hospital will be screened for eligibility and enrollment in the study to receive weekly measurements of nerve and muscle function through nerve conduction studies (NCS), muscle ultrasound tests, and concentric needle electromyography (EMG) tests.

Collected data includes the subject's age, gender, race, ethnicity, length of stay in ICU, time on mechanical ventilation and pertinent medical history that could indicate baseline neuromyopathy (CNS disease, diabetes, HIV, alcohol use disorder). Baseline neurological examination will be performed within 48 hours of meeting the inclusion criteria. This examination will include the level of consciousness, muscle tone, motor strength using the Medical Research Council (MRC) Scale, sensory function, muscle stretch reflexes, and plantar responses. For MRC testing, six muscle groups will be tested bilaterally: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and foot dorsiflexion. Clinical weakness on examination (which is necessary to make the diagnosis of CIPNM (Critical Illness Polyneuropathy and Myopathy)) is defined as an MRC score equal to or less than 48 (maximum score is 60). If a subject cannot participate in any MRC strength testing (e.g. due to sedation or encephalopathy) they will be coded at the lowest level (most severe clinical weakness). Nerve conduction studies (NCS) and concentric needle electromyography (EMG) will be performed (as described below) on the same day as the initial neurological examination. The neurological examination and NCS/EMG will be repeated on a weekly basis until CIPNM is diagnosed or the subject is discharged from the ICU.

SPECIFIC AIM #1:

Aim 1.1: To determine whether amplitude reductions in the peroneal and sural nerve action potentials on NCS can serve as accurate screening tests for CIPNM in patients with acute respiratory failure.

Aim 1.2: To determine whether increased duration of the CMAP on NCS can serve as an accurate screening test for CIPNM in patients with acute respiratory failure.

Aim 1.3: To determine whether changes in muscle ultrasound echogenicity and/or thickness can serve as accurate screening tests for CIPNM in patients with acute respiratory failure.

Aim 1.4: To determine the incidence of CIPNM in patients with neurological critical illness (such as intraparenchymal and subarachnoid hemorrhage), which requires prolonged length of stay in a neurosurgical intensive care unit.

Being tested
Muscle Ultrasound, Nerve Conduction Study, Electromyography
Medical subject headings
Critical Illness

What participants receive

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

  • Muscle UltrasoundOther

    Also called US, Ultrasound

    Ultrasound will be performed using a linear-array transducer with standardized gain and varying depth based on the amount of overlying soft tissue and muscle size. The subjects will be examined in the supine position with extended limbs and relaxed muscles. We will perform bilateral scans of the biceps, anterior forearm, and anterior thigh at standardized sites. For muscle echogenicity measurements, we will scan the same muscles at the same points.

  • Nerve Conduction StudyOther

    Also called NCS

    Nerve Conduction Studies will be performed using a Nicolet EDX using standard procedures. Repetitive stimulation of the median motor nerve are performed in all subjects. Bilateral sural, radial and median sensory nerves will be analyzed. We will only perform surface, not subdermal sensory recordings. The bilateral peroneal, tibial and median motor responses will be recorded over extensor digitorum brevis, abductor hallucis brevis, and abductor pollicis brevis muscles. The peroneal motor nerve will be stimulated at the fibular head and lateral popliteal fossa, recording from the tibialis anterior muscle. The compound motor action potential (CMAP) responses will be elicited from standard distal and proximal sites.

  • ElectromyographyOther

    Also called EMG

    EMG studies will be performed using standard precautions. Insertional activity, spontaneous activity, motor unit potential (MUP) morphology and recruitment/activation pattern will be recorded from some combination of the deltoid, triceps, biceps, first dorsal interosseous, abductor pollicis brevis, iliopsoas, vastus medialis, and tibialis anterior muscles. The specific muscles studied for each patient will vary according to the patient's level of consciousness and ability to activate the muscles either voluntarily or during spontaneous limb movement. If possible, we will try to examine 3 unilateral upper extremity and 3 unilateral lower extremity muscles. If a patient is not able to volitionally participate in EMG testing (by contracting their muscles on command), we will analyze insertional/spontaneous activity and potentially morphology/recruitment (e.g. stroking the sole of the foot to stimulate contraction of the tibialis anterior).

Study groups in NCT02634658
Study groupRoleWhat they receive
Medical ICU SubjectsExperimentalAll Medical ICU subjects that meet eligibility criteria and are enrolled in the study will receive muscle Ultrasounds, Nerve Conduction Studies and Electromyography (EMG).
Receives: Other: Muscle Ultrasound; Other: Nerve Conduction Study; Other: Electromyography
Neuro ICU SubjectsExperimentalAll Neuro ICU subjects that meet eligibility criteria and are enrolled in the study will receive Nerve Conduction Studies and Electromyography (EMG).
Receives: Other: Nerve Conduction Study; Other: Electromyography

What is being measured

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

  1. Aims 1.1-1.3: Number of medical ICU subjects diagnosed with CIPNM according to Moss/Quan established criteria of CIP or CIM.

    Subjects have CIPNM if either Moss/Quan criteria for (CIP) or (CIM) criteria are met:

    CIP:

    SNAP amplitudes < 80% of lower norm limit of 2+ nerves, Reduced recruitment on EMG, Absence of decremental response, and MRC score < 48 or clinical weakness on exam

    CIM:

    SNAP amplitudes > 80% of the lower norm limit of 2+ nerves, CMAP amplitudes < 80% of the lower limit of normal in two or more nerves without conduction block, needle EMG with short-duration, low amplitude motor unit potentials with early recruitment, absence of a decremental response, and MRC score < 48 or clinical weakness on exam

    CIPNM:

    Absence of a decremental response, SNAP amplitudes < 80% of the lower limit of normal in two or more nerves, CMAP amplitudes < 80% of the lower limit of normal in two or more nerves without conduction block, sustained spontaneous activity and/or changes in motor unit recruitment, in at least two muscles, and MRC score < 48 or clinical weakness on exam

    Measured: Weekly up to Day 28 or hospital discharge whichever occurs first.

  2. Aim 1.4: Number of neurosurgical ICU subjects diagnosed with CIPNM according to Moss/Quan established criteria of CIP or CIM.

    Subjects have CIPNM if either Moss/Quan criteria for (CIP) or (CIM) criteria are met:

    CIP:

    SNAP amplitudes < 80% of lower norm limit of 2+ nerves, Reduced recruitment on EMG, Absence of decremental response, and MRC score < 48 or clinical weakness on exam

    CIM:

    SNAP amplitudes > 80% of the lower norm limit of 2+ nerves, CMAP amplitudes < 80% of the lower limit of normal in two or more nerves without conduction block, needle EMG with short-duration, low amplitude motor unit potentials with early recruitment, absence of a decremental response, and MRC score < 48 or clinical weakness on exam

    CIPNM:

    Absence of a decremental response, SNAP amplitudes < 80% of the lower limit of normal in two or more nerves, CMAP amplitudes < 80% of the lower limit of normal in two or more nerves without conduction block, sustained spontaneous activity and/or changes in motor unit recruitment, in at least two muscles, and MRC score < 48 or clinical weakness on exam

    Measured: Weekly through Day 28 or hospital discharge whichever occurs first

Secondary outcomes (7)
  1. ICU length of stay

    ICU length of stay

    Measured: upon completion of ICU stay, commonly 7-14 days.

  2. ICU-free days

    the number of days out of 28 that the subject is alive and out of the ICU, but remains hospitalized.

    Measured: upon completion of inpatient period, commonly up to 28 days.

  3. time on mechanical ventilation

    time on mechanical ventilation

    Measured: upon completion of ventilation period, commonly 3-14 days.

  4. hospital length of stay

    hospital total length of subject stay.

    Measured: upon completion of inpatient period, commonly up to 28 days.

  5. hospital-free days

    the number of days oout of 28 that the subject was alive and out of the acute care hospital.

    Measured: 28 days

  6. in hospital mortality

    Incidence of in hospital mortality through day 28

    Measured: 28 days

  7. Discharge location

    Subject discharge location from acute hospitalization period to home, SNF, rehab hospital, LTACH, hospice, etc.

    Measured: up to 28 days

Timeline

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

  1. First posted18 Dec 2015 (estimated)
  2. Study startJun 2009
  3. Primary completionApr 2014
  4. Study completionSep 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
Diagnosis
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
120 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02634658
Sponsor's protocol ID
15-1557
Status last verified
May 2017
First submitted
13 Nov 2015
Last updated
4 May 2017
Results posted
No
Data monitoring committee
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Muscle Ultrasound, Nerve Conduction Study and Electromyography in people with Critical Illness, run by University of Colorado, Denver at 1 site in United States.

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 19 inclusion and 25 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 4 May 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. 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?

Aims 1.1-1.3: Number of medical ICU subjects diagnosed with CIPNM according to Moss/Quan established criteria of CIP or CIM. (time frame: Weekly up to Day 28 or hospital discharge whichever occurs first.). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 4 May 2017.

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