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Septic ShockPhase 2NCT03366220

Resuscitation With Plasma in Surgical and Trauma Patients With Septic Shock

A Phase 2 study testing Plasma and Balanced crystalloids in people with Septic Shock, run by The University of Texas Health Science Center, Houston at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

There is a knowledge gap regarding the optimal initial fluid to achieve effective resuscitation and improved outcomes in septic shock. The purpose of this study is to compare initial resuscitation with plasma to initial resuscitation with balanced crystalloids. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Septic Shock
What is being tested?
Plasma and Balanced crystalloids
Could I receive a placebo?
No, everyone receives an active treatment
How many people
16 participants
Where
1 siteUnited States
Study dates
26 Mar 2018to 16 Oct 2019
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

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

  • Patients meeting the following criteria will be enrolled: Have a Sepsis Screening Score (SSS) ≥ 4 with a suspected source of infection (Table 1); and Written informed consent obtained
  • Patients meeting any of the following criteria will be randomized: Hypotension with MAP < 65 mmHg; Lactic acid > 4 mmol/L; Altered mental status; and Decreased urine output of < 0.5 mL/kg in the past hour.

Who cannot join

  • Pregnancy
  • Prisoners
  • Traumatic brain injury
  • Evidence of ongoing hemorrhage, history of congenital bleeding disorders, therapeutic anticoagulation
  • History of myocardial infarction or congestive heart failure
  • History of acute cerebral vascular event
Show all 14Show fewer
  • Major burns (>20% total body surface area)
  • History of adverse reactions to blood product transfusion
  • Contraindications to blood transfusions (eg. Jehovah's Witness)
  • Contraindications to central venous line and arterial line placement
  • On intermittent hemodialysis
  • Do-Not-Resuscitate or Comfort Care status
  • Participation in another interventional study
  • Pending transfer to another unit within the hospital that is not STICU or SIMU

Trial locations and contacts

1 site in 1 country.

United States1 site
  • The University of Texas Health Science Center at Houston

    Houston, Texas, 77030

Other trials in United States

About this study

There is a knowledge gap regarding the optimal initial fluid to achieve effective resuscitation and improved outcomes in septic shock. The purpose of this study is to compare initial resuscitation with plasma to initial resuscitation with balanced crystalloids.

Conditions
Septic Shock
Being tested
Plasma, Balanced crystalloids
Medical subject headings
Shock, Septic

What participants receive

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

  • PlasmaDrug

    Initial resuscitation with plasma will be 10 mL/kg (700 mL in a typical 70 kg adult). Traditional doses of plasma, when used to correct coagulopathy range from 10-15 mL/kg.23 The plasma will be administered at a rate of 2-3 mL/kg/hr (140-210 mL/hr in a typical 70 kg adult). A research physician will be at bedside to follow patient resuscitation. Plasma administration may be terminated before the entire dose is administered if patients show clinical improvement. After the initial dose of plasma has been given, subsequent resuscitation will follow usual care using balanced crystalloids.

  • Balanced crystalloidsDrug

    Usual care using balanced crystalloids (Iso-Lyte or Plasma-Lyte) only will follow Surviving Sepsis Campaign guidelines. Controls will receive 30 mL/kg (2100 mL in a typical 70 kg adult) of crystalloids within the first 3 hours. Subsequent resuscitation with balanced crystalloids will be titrated to the endpoints of resuscitation.

Study groups in NCT03366220
Study groupRoleWhat they receive
initial resuscitation with plasmaExperimentalInitial resuscitation with plasma will be 10 mL/kg (700 mL in a typical 70 kg adult). Traditional doses of plasma, when used to correct coagulopathy range from 10-15 mL/kg.23 The plasma will be administered at a rate of 2-3 mL/kg/hr (140-210 mL/hr in a typical 70 kg adult). A research physician will be at bedside to follow patient resuscitation. Plasma administration may be terminated before the entire dose is administered if patients show clinical improvement. After the initial dose of plasma has been given, subsequent resuscitation will follow usual care using balanced crystalloids.
Receives: Drug: Plasma
initial resuscitation with balanced crystalloidsActive comparatorUsual care using balanced crystalloids (Iso-Lyte or Plasma-Lyte) only will follow Surviving Sepsis Campaign guidelines. Controls will receive 30 mL/kg (2100 mL in a typical 70 kg adult) of crystalloids within the first 3 hours. Subsequent resuscitation with balanced crystalloids will be titrated to the endpoints of resuscitation.
Receives: Drug: Balanced crystalloids

What is being measured

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

  1. Glycocalyx Breakdown as Assessed by Syndecan-1 Levels

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and at 24 hours

  2. Glycocalyx Breakdown and Endothelial Leakage as Assessed by Soluble Thrombomodulin (sTM)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and 24 hours

  3. Endothelial Leakage as Assessed by Soluble FMS-like Tyrosine Kinase-1 (sFLT-1)

    Measured: 0, 2, end of initial bolus of fluid administration(about 3 hours), 12, and 24 hours

  4. Endothelial Leakage and Inflammation as Assessed by Vascular Endothelial Growth Factor (VEGF)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and 24 hours

  5. Sympatho-adrenal Activation as Assessed by Norepinephrine (NE)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and 24 hours

  6. Sympatho-adrenal Activation as Assessed by Epinephrine (Epi)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and 24 hours

  7. Inflammation as Assessed by Soluble Receptor for Advanced Glycation Endproduct (sRAGE)

    Measured: 0, 2, end of initial bolus of fluid administration, 12, and 24 hours

  8. Inflammation as Assessed by High Mobility Group Protein-1 (HMGB-1)

    Measured: 0, 2, end of initial bolus of fluid administration, 12, and 24 hours

  9. Inflammation as Assessed by Interleukin-6 (IL-6)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and 24 hours

  10. Inflammation as Assessed by Interleukin-8 (IL-8)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours) , 12, and 24 hours

  11. Inflammation as Assessed by Interleukin-10 (IL-10)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and 24 hours

  12. Inflammation as Assessed by Interleukin-1α (IL-1α)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and 24 hours

  13. Inflammation as Assessed by Interleukin-1β (IL-1β)

    Measured: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and 24 hours

Secondary outcomes (9)
  1. Total Volume of Fluid Required for Resuscitation After the Initial Bolus of Either Plasma or Crystalloids

    Data were not collected for 1 participant in the initial resuscitation with plasma arm.

    Measured: First 24 hours after initiation of fluid resuscitation

  2. Time Until Lactate Normalization

    Measured: First 24 hours after initiation of fluid resuscitation

  3. Time on Vasopressors

    Measured: First 30 days after initiation of fluid resuscitation

  4. Number of Days on Ventilator Support

    Measured: First 30 days after initiation of fluid resuscitation

  5. Number of Intensive Care Unit (ICU)-Free Days

    Measured: First 30 days after initiation of fluid resuscitation

  6. Number of Hospital Days

    Measured: From the time of initiation of fluid resuscitation to the time of hospital discharge (up to about 170 days)

  7. Mortality

    Measured: First 30 days after initiation of fluid resuscitation

  8. Number of Participants With Acute Lung Injury

    Measured: First 30 days after initiation of fluid resuscitation

  9. Number of Participants With Acute Kidney Injury

    Measured: First 30 days after initiation of fluid resuscitation

Timeline

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

  1. First posted8 Dec 2017
  2. Study start26 Mar 2018
  3. Primary completion17 Sep 2019
  4. Study completion16 Oct 2019

Why it stopped: The study was halted early due to low patient accrual secondary to COVID-19 and significant heterogeneity in clinical manifestations of sepsis precluding enrollment.

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
16 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03366220
Sponsor's protocol ID
HSC-MS-17-0714
Status last verified
Apr 2022
First submitted
1 Dec 2017
Last updated
13 Apr 2022
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Wei S, Kao LS, Wang HE, Chang R, Podbielski J, Holcomb JB, Wade CE. Protocol for a pilot randomized controlled trial comparing plasma with balanced crystalloid resuscitation in surgical and trauma patients with septic shock. Trauma Surg Acute Care Open. 2018 Sep 23;3(1):e000220. doi: 10.1136/tsaco-2018-000220. eCollection 2018.

    PubMed 30271882

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Plasma and Balanced crystalloids in people with Septic Shock, run by The University of Texas Health Science Center, Houston 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 2 inclusion and 14 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: stopped early, as of the sponsor's last update on 13 Apr 2022. 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.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 13 Apr 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Glycocalyx Breakdown as Assessed by Syndecan-1 Levels (time frame: 0, 2, end of initial bolus of fluid administration (about 3 hours), 12, and at 24 hours). The study lists 13 primary outcomes in all. 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 NCT03366220, which also lists 1 linked publication.

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 13 Apr 2022.

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