Restlessness
Conditions
Keywords
restlessness during mechanical ventilation weaning
Brief summary
This study aims to assess the efficacy of a drug (loxapine, a neuroleptic) in calming patients down in a situation of restlessness during mechanical ventilation weaning. This drug is used for several years to quieten restless patients. Its purpose is to restore spontaneous breathing sooner and therefore to reduce the risks of intubation and mechanical ventilation.
Detailed description
This study aims to assess the efficacy of a drug (loxapine, a neuroleptic) in calming patients down in a situation of restlessness during mechanical ventilation weaning. This drug is used for several years to quieten restless patients. Its purpose is to restore spontaneous breathing sooner and therefore to reduce the risks of intubation and mechanical ventilation. 300 patients will participate in the study and will be randomized, after informed consent, to receive either loxapine or a placebo.Patients whose proxies refuse participation will be sedated according to standard care procedures.
Interventions
DRUGloxapine
Each patient may receive a maximum dosage of 900mg of Loxapine per day (drinkable solution through gastric probe) or the same volume of placebo. 2 initial administrations of 150 mg followed by potential readministration of 100 mg of loxapine. Maximum duration of treatment will be 14 days.The dosage by day is defined by patients' clinical condition, assessed with RASS score.
DRUGPlacebo
Placebo
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age ≥ 18 years, * sedated * under mechanical ventilation through intubation probe for more than 48 hours * no contra-indication to naso-gastric probe- with criteria for potential weaning * with social security * important restlessness at sedation withdrawal, defined as RASS score (Richmond Agitation Sedation Scale)= 2. This restlessness has no potential danger for the patient but requires a level of sedation. This re-sedation implies administration of morphinomimetics and benzodiazepines at dosages that does not allow to pursue mechanical ventilation weaning attempts.
Exclusion criteria
* extreme restlessness at sedation withdrawal ((RASS\>2) * allergy to loxapine or one of its component * dopaminergic agonists * extubation planned in the following 24 hours * antecedent of comitiality * known pregnancy at admission * proxies opposed to study participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Weaning period | up to 28 days | Weaning period (days) between inclusion (ie first administration of loxapine/placebo) and successful extubation (no re-intubation in the following 48 hours) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| incidence of unexpected extubations | up to 28 days | number of patients with unexpected extubation |
| clinical and biological respiratory parameters | 24 hours | description of abnormal clinical and biological respiratory parameters, number of patients concerned. |
| incidence of mechanical ventilation related complications | up to 48 hours after extubation | collapses, nosocomial pneumonia, respiratory issue requiring an increase of FiO2 and/or PEP. |
| total duration of mechanical ventilation | up to 28 days | -number of days of mechanical ventilation |
| mortality rate | day 14 and week 6 | mortality rate at day 14 and week 6 |
| factors associated to weaning failure | up to 28 days | age, patient medical history,duration of sedation or ventilation, weaning failure |
| incidence of adverse events, related and non related to the treatment | up to 28 days | — |
Countries
France
Outcome results
None listed