Analgesia in the critically ill Signs and Symptoms Analgesia
Conditions
Interventions
Assessment of sedation and pain scores with initial titration of the opioid to effect, monitoring of haemodynamics.
Sponsors
GlaxoSmithKline (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: A subject will be eligible for inclusion in this study only if all of the following criteria apply: 1. Admitted into the ICU within the previous 24 hours 2. Intubated and expected to require short-term mechanical ventilation (i.e. for at least a further 12 hours and up to 72 hours after starting the study drug infusion) 3. Aged over 18 years old 4. A female is eligible to enter and participate in this study if she is of: 4.1. Non-childbearing potential (i.e., physiologically incapable of becoming pregnant, including any female who is post-menopausal) or, 4.2. Child-bearing potential, has a negative pregnancy test (urine or serum) at screen, and agrees to one of the following: 4.2.1. Complete abstinence from intercourse from two weeks prior to administration of study drug, throughout the study, and for a time interval after completion or premature discontinuation from the study to account for elimination of the investigational drug (minimum of 7 days) 4.2.2. Female sterilisation 4.2.3. Sterilisation of male partner 4.2.4. Implants of levonorgestrel 4.2.5. Injectable progestogen 4.2.6. Oral contraceptive (combined or progestogen only) 4.2.7. Any intrauterine device (IUD) with published data showing that the highest expected failure rate is less than 1% per year (not all IUDs meet this criterion) 4.2.8. Any other methods with published data showing that the highest expected failure rate for that method is less than 1% per year 4.2.9. Barrier method only if used in combination with one of the above methods 5. Weighs an estimated 120 kg or less 6. Informed consent: a signed and dated written informed consent or assent must be obtained from the subject or the subject's legally acceptable representative, respectively, prior to study participation 7. Language: fluent and literate in the language spoken by the investigator and staff
Exclusion criteria
Exclusion criteria: A subject will not be eligible for inclusion in this study if any of the following criteria apply: 1. Concurrent medications: 1.1. Requires neuromuscular blocking agents to facilitate mechanical ventilation 1.2. Has or is likely to receive an epidural block during the maintenance phase 2. The use of remifentanil, fentanyl or propofol is contraindicated 3. Concurrent disease or disorder: 3.1. Has or is likely to require a tracheostomy within 96 hours after admission to the ICU 3.2. Has a neurological disease or other medical condition that may affect the ability to assess the SAS score and PI (e.g. stroke, stupor or coma, dementia) 3.3. Predicted creatinine clearance of <50 mL/min indicating moderate or severe renal impairment 3.4. Modified ICU admission simplified acute physiology score (SAPS) II score of greater than 43 4. Drug allergy: history of allergic hypersensitivity to fentanyl analogues, morphine, benzodiazepines or propofol 5. History of alcohol abuse 6. History of drug abuse: clinically significant abuse of opioid or sedative containing substances, defined as: 6.1. Patterns of substance intake consistent with disruption of normal function in society 6.2. Past or current impairment of organ function reasonably related to substance intake 7. Previous entry into this study or participation in any other investigational drug study within 30 days of randomisation 8. Concurrently participating in another clinical study in which the subject is or will be exposed to an investigational or a non-investigational drug or device 9. Protocol specified treatment regimens would be inappropriate for the management of the subject 10. The subject will have been in the ICU for longer than 24 hours at the time of starting the study drug infusion
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Between-subject variability around the mean percentage of hours of optimal sedation (Sedation Agitation Scale [SAS] score of 4). | — |
Secondary
| Measure | Time frame |
|---|---|
| Efficacy: 1. Mean percentage of hours subjects were optimally sedated (SAS score of 4) during the treatment and post-treatment periods 2. Mean percentage of hours subjects were inadequately sedated (SAS score of 5, 6 or 7) during the treatment and post-treatment periods 3. Mean percentage of hours subjects were excessively sedated (SAS score of 1, 2 or 3) during the treatment and post-treatment periods 4. Mean percentage of hours subjects were dangerously agitated (SAS score of 7) during the treatment and post-treatment periods 5. Mean percentage of hours subjects were unarousable (SAS score of 1) during the treatment and post-treatment periods 6. Mean percentage of hours of no/mild pain during the treatment and post-treatment periods 7. Time between start of the extubation process and actual extubation 8. Total time on mechanical ventilation within the treatment period 9. Time between extubation and ICU discharge 10. Time from the start of study drug until ICU discharge Other: 1. Weighted mean infusion rates of remifentanil, fentanyl and propofol 2. Total exposure to study opioid and propofol including frequency of opioid infusion rate changes, and propofol infusion rate changes (from starting the opioid infusion until it was discontinued) 3. Incidence of supplementary open-label propofol and fentanyl bolus doses administered for stimulating procedures during the treatment period 4. Incidence of open-label propofol and fentanyl bolus doses administered for rescue treatment during the maintenance phase 5. Incidence of supplementary open-label propofol, fentanyl, morphine and bupivacaine bolus doses administered for analgesia/sedation during the extubation and post-extubation phases Safety: 1. Haemodynamic parameters during and after treatment (mean arterial pressure [MAP] and heart rate [HR]) 2. Respiratory function (post-extubation only - respiratory rate [RR], fractional inspired oxygen concentration [FiO2] and peripheral oxygen saturation [SpO2 | — |
Countries
Belgium, Germany, Netherlands, Spain, United Kingdom
Outcome results
None listed