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Mechanical VentilationNCT04788589

Sedation and Ventilator Weaning Protocol in PICU

A study testing Sedation and ventilator weaning protocol in people with Mechanical Ventilation and Sedation, run by Universitas Indonesia at 1 site in Indonesia.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This research is a single-blinded, randomized controlled trial involving mechanically ventilated children in Pediatric Intensive Care Unit, Cipto Mangunkusumo Hospital, Indonesia. Subjects were divided into two groups: intervention vs control group. Read more about this study

Who is it for?
Ages 1 month to 17 years
Conditions the study is for
Mechanical Ventilation, Sedation
What is being tested?
Sedation and ventilator weaning protocol
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteIndonesia
Study dates
1 Sep 2020to 1 Jul 2022
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 1 month to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Patient who need mechanical ventilation for more than 12 hours

Who cannot join

  • PICU admission due to post cardiac and respiratory arrest

Trial locations and contacts

1 site in 1 country.

Indonesia1 site
  • Cipto Mangunkusumo Hospital

    Jakarta Pusat, DKI Jakarta, 10430

Other trials in Indonesia

About this study

Official title: Effectiveness of Sedation and Ventilator Weaning Protocol - a Randomized Controlled Trial

This research is a single-blinded, randomized controlled trial involving mechanically ventilated children in Pediatric Intensive Care Unit, Cipto Mangunkusumo Hospital, Indonesia. Subjects were divided into two groups: intervention vs control group. Primary and secondary outcomes will be measure pre, during, and post treatment.

Read the detailed description

As of today, there is no sedation and ventilator weaning protocol in our PICU. Decision for sedation and ventilator weaning were based on attending physicians clinical judgement, which greatly varies among individual. Previous study on the use of these protocols showed a favorable outcome. We aim to assess the safety and effectiveness of this protocol in our PICU.

Subjects were recruited consecutively and randomized into intervention and control group.

  • Intervention group: sedation and ventilator weaning protocol
  • Control group: no protocol

Primary outcomes:

  • FLACC score
  • COMFORT score
  • Ventilator days

Secondary outcomes:

  • Self extubation
  • Reintubation
  • PICU Length of stay
  • Frequency of asynchrony
  • NIRS value
  • VIS score
Being tested
Sedation and ventilator weaning protocol

What participants receive

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

  • Sedation and ventilator weaning protocolOther

    Subjects randomized to this group will underwent sedation and ventilator weaning protocol as mentioned before.

Study groups in NCT04788589
Study groupRoleWhat they receive
Sedation and Ventilator Weaning ProtocolExperimentalSedation: start midazolam 5-10 mins (max 3x). If MV 12 hrs-2d: Pain: morphine @2 hrs if needed (max 10mg/x). Sedation: midazolam @ 1-2 hrs if needed (max 10mg/x). If MV >2 d: morphine \& midazolam drip (max 10mg/hr). MV weaning checklist @morning. Pass if no incr of sedation dose due to agitation, NMBAs, incr in ICP. Fail: reassessed tomorrow. Pain and SBS scores assessed @morning until extubation. Stop all sedation and analgetic for sedation. Continue analgetics for pain. Subjects monitored for 4 hrs. Assess pain and WAT-1 score. Pass (GCS of E3, tolerate sedation interruption for > 4 hrs): MV weaning protocol. Fail (Persistent anxiety/agitation, incr pain score, incr RR > 5 mins, SpO2 <88% >5 mins, acute heart dysrhythmia, >=2 signs of ARDS): sedation resumed ½ dose, up titrated. MV weaning: CPAP 5/PS < 7. Pass: No failure criteria for 2 hrs. Fail (Incr RR > 5 mins, SpO2 <88% > 5 mins, acute decr in GCS/acute heart dysrhythmia, >=2 signs of ARDS): previous MV setting.
Receives: Other: Sedation and ventilator weaning protocol
ControlNo intervention1. Informed consent 2. Randomization into groups 3. Sedation and ventilator weaning according to attending physicians 4. Pain scores and SBS score is noted every 6 hours for the first 24 hours, and every day for the next 24 hours until extubation. 5. Attending physicians assessed that subject could be weaned: pain scores, SBS score, WAT-1 score 6. Extubation. Researcher did not take part in the judgement of extubation.

What is being measured

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

  1. Face, Leg, Activity, Cry, Consolability (FLACC) score hour 0

    Pain scoring. Each characteristic has 0-2 points with maximum 10 points. The greater number indicate greater pain score.

    Measured: every 6 hours for the first 24 hours, once daily until extubation. This is the baseline. Once the patient was intubated, FLACC scoring of hour 0 will be assessed and noted.

  2. Face, Leg, Activity, Cry, Consolability (FLACC) score hour 6

    Pain scoring. Each characteristic has 0-2 points with maximum 10 points. The greater number indicate greater pain score.

    Measured: FLACC scoring of hour 6 will be measured 6 hours after hour 0 was measured. Hour 6 is measured from the time the subject was intubated.

  3. Face, Leg, Activity, Cry, Consolability (FLACC) score hour 12

    Pain scoring. Each characteristic has 0-2 points with maximum 10 points. The greater number indicate greater pain score.

    Measured: FLACC scoring of hour 12 will be measured 12 hours after hour 0 was measured. Hour 12 is measured from the time the subject was intubated.

  4. Face, Leg, Activity, Cry, Consolability (FLACC) score hour 18

    Pain scoring. Each characteristic has 0-2 points with maximum 10 points. The greater number indicate greater pain score.

    Measured: FLACC scoring of hour 18 will be measured 18 hours after hour 0 was measured. Hour 18 is measured from the time the subject was intubated.

  5. Face, Leg, Activity, Cry, Consolability (FLACC) score day 1 until extubation

    Pain scoring. Each characteristic has 0-2 points with maximum 10 points. The greater number indicate greater pain score.

    Measured: Scoring will be assessed every morning. If the subject was intubated at night, scoring for day 1 will be measured in the morning the day after tomorrow. Thereafter, the measurement will be taken every morning, 24 hour apart until the subject extubation.

  6. Face, Leg, Activity, Cry, Consolability (FLACC) score extubation day

    Pain scoring. Each characteristic has 0-2 points with maximum 10 points. The greater number indicate greater pain score.

    Measured: This score will be taken when the subject was stopped from all sedative and analgetics, just before extubation. Monitoring of extubation will be conducted until 56 days after initial intubation.

  7. COMFORT score hour 0

    Sedation scoring. It consists of 8 components. Each component has a score of 1-5, max score 40. Scores of 8 - 17 are over-sedated, scores between 17 - 26 are adequately sedated, and scores between 27 - 40 are under-sedated

    Measured: This is the baseline. Once the patient was intubated, COMFORT scoring of hour 0 will be assessed and noted.

  8. COMFORT score hour 6

    Sedation scoring. It consists of 8 components. Each component has a score of 1-5, max score 40. Scores of 8 - 17 are over-sedated, scores between 17 - 26 are adequately sedated, and scores between 27 - 40 are under-sedated

    Measured: COMFORT scoring of hour 6 will be measured 6 hours after hour 0 was measured. Hour 6 is measured from the time the subject was intubated.

  9. COMFORT score hour 12

    Sedation scoring. It consists of 8 components. Each component has a score of 1-5, max score 40. Scores of 8 - 17 are over-sedated, scores between 17 - 26 are adequately sedated, and scores between 27 - 40 are under-sedated

    Measured: COMFORT scoring of hour 12 will be measured 12 hours after hour 0 was measured. Hour 12 is measured from the time the subject was intubated.

  10. COMFORT score hour 18

    Sedation scoring. It consists of 8 components. Each component has a score of 1-5, max score 40. Scores of 8 - 17 are over-sedated, scores between 17 - 26 are adequately sedated, and scores between 27 - 40 are under-sedated

    Measured: COMFORT scoring of hour 18 will be measured 18 hours after hour 0 was measured. Hour 18 is measured from the time the subject was intubated.

  11. COMFORT score day 1 until extubation

    Sedation scoring. It consists of 8 components. Each component has a score of 1-5, max score 40. Scores of 8 - 17 are over-sedated, scores between 17 - 26 are adequately sedated, and scores between 27 - 40 are under-sedated

    Measured: Scoring will be assessed every morning. If the subject was intubated at night, scoring for day 1 will be measured in the morning the day after tomorrow. Thereafter, the measurement will be taken every morning, 24 hour apart until the subject extubation.

  12. COMFORT score extubation day

    Sedation scoring. It consists of 8 components. Each component has a score of 1-5, max score 40. Scores of 8 - 17 are over-sedated, scores between 17 - 26 are adequately sedated, and scores between 27 - 40 are under-sedated

    Measured: This score will be taken when the subject was stopped from all sedative and analgetics, just before extubation. Monitoring of extubation will be conducted until 56 days after initial intubation.

  13. Ventilator time

    Time to extubation (days)

    Measured: From intubation to extubation which would not need reintubation within 48 hours of extubation, measurement of the time frame may be assessed up to 28 days measured from intubation time.

Secondary outcomes (9)
  1. Reintubation frequency

    Number of times subject was reintubated within 48 hours after extubation

    Measured: Frequency of subject who are extubated to be reintubated within 48 hours after extubation. Assessment will be noted up to 28 days measured from the first time intubation was performed.

  2. Self extubation frequency

    Number of times subject was self extubated during one episode of intubation

    Measured: Frequency of self extubation by the patient during one episode of intubation. Assessment will be noted up to 28 days measured from the first time intubation was performed.

  3. PICU length of stay

    Days from PICU admission to death or move outside the PICU to the ward

    Measured: Length of stay in PICU from admission until patient's death or step-down to the pediatric ward. Assessment of PICU length of stay will be noted up to 56 days measured from the first day of PICU admission as day 1.

  4. Near infrared spectroscopy minute 5

    Value of Near infrared spectroscopy (NIRS) during minute 5 after administration of sedatives or analgetic. NIRS values of less than 40% for 10 minutes or a 20% decrease from baseline indicated anaerobic metabolism and ischemic brain injury.

    Measured: The scoring will be noted during minute-5 after sedatives/analgetic administration following intubation.

  5. Near infrared spectroscopy hour-1

    Value of Near infrared spectroscopy (NIRS) during minute 5 after administration of sedatives or analgetic. NIRS values of less than 40% for 10 minutes or a 20% decrease from baseline indicated anaerobic metabolism and ischemic brain injury.

    Measured: The scoring will be noted during hour-1 after sedatives/analgetic administration following intubation.

  6. Near infrared spectroscopy hour-6

    Value of Near infrared spectroscopy (NIRS) during minute 5 after administration of sedatives or analgetic. NIRS values of less than 40% for 10 minutes or a 20% decrease from baseline indicated anaerobic metabolism and ischemic brain injury.

    Measured: The scoring will be noted during hour-6 after sedatives/analgetic administration following intubation.

  7. Near infrared spectroscopy hour-12

    Value of Near infrared spectroscopy (NIRS) during minute 5 after administration of sedatives or analgetic. NIRS values of less than 40% for 10 minutes or a 20% decrease from baseline indicated anaerobic metabolism and ischemic brain injury.

    Measured: The scoring will be noted during hour-12 after sedatives/analgetic administration following intubation.

  8. Inotropic intervention

    All inotropes used will be noted as secondary outcome to identify the hypotensive and/or bradycardia complications that might be caused due to usage of sedatives and analgesia. The usage will be divided into two categories: Yes and No usage of inotrope

    Measured: The inotropic intervention will be noted throughout PICU admission up to 14 days of mechanical ventilation days.

  9. Vasoactive-Inotropic Score

    The VIS were extracted from the formula: dopamine dose (μg/kg/minute) + dobutamine dose (μg/kg/minute) + 100 x epinephine dose (μg/kg/minute) + 10 x milrinone dose (μg/kg/minute) + 10,000 x vasopressine dose (unit/kg/minute) + 100 x norepinefrine dose (μg/kg/minute). The VIS score was categorized into two (≥20 dan <20).

    Measured: The VIS score will be measured once during PICU admission up to 14 days of mechanical ventilation days.. The highest value will be recorded and categorized into two groups

Timeline

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

  1. First posted9 Mar 2021
  2. Study start1 Sep 2020
  3. Primary completion1 Jan 2022
  4. Study completion1 Jul 2022 (estimated)

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
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04788589
Sponsor's protocol ID
20030379
Status last verified
Jun 2022
First submitted
13 Feb 2021
Last updated
14 Jun 2022
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Sedation and ventilator weaning protocol in people with Mechanical Ventilation and Sedation, run by Universitas Indonesia at 1 site in Indonesia.

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 1 inclusion and 1 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: status not confirmed, as of the sponsor's last update on 14 Jun 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 Indonesia. 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?

Results are not available in the source record.

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?

Face, Leg, Activity, Cry, Consolability (FLACC) score hour 0 (time frame: every 6 hours for the first 24 hours, once daily until extubation. This is the baseline. Once the patient was intubated, FLACC scoring of hour 0 will be assessed and noted.). 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?
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 14 Jun 2022.

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