ernstig zieke intensive care patienten sepsis
Conditions
Interventions
Patients accepted for this study are randomised to either the ketanest (K) or
etomidate (E) group. The primary objective in patients with septic shock is
restoration of adequate tissue perfusion. Th
Sponsors
Vrije Universiteit Medisch Centrum
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: 1. fullfilling SIRS criteria with a supposed infectious cause, 2. in need for ventilatory support. 3. to be intubated on the ICU.
Exclusion criteria
Exclusion criteria: 1. 80 years old. 2. symptomatic coronary artery disease. 3. due to have surgery within 4 hours. 4. already on corticosteroid therapy 5. pregnancy. 6. pulmonary hypertension.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| These variables are measured every hour during the first 8 hours. However, these variables will be measured every 10 minutes during: 1. the first 2 hours following the induction of anesthesia (0-1h) 2. the first 2 hours after the switch to midazolam/fentanyl anesthesia (2-3). CVP (10 min average) HR/BP (10 min average) MAP (10 min average) Urine output (60 min average) ScvO2 Resuscitation volume (specific sum) Inotropic support (value of rate and cumulative dose) Vasopressor support (value of rate and cumulative dose) | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. ventilatory and oxygen delivery variables Airway pressures / FiO2 / tidal volume / Arterial blood analysis / Lactate/Hb, are measured every hour during the first 4 hours, and after 8 hours. 2. Adverse psychological reactions During the observation period, checking the medical record upto 24 hours after induction, and, if possible, asking the patient for adverse psychological effects as soon as possible after awaking and after extubation. 3. Adrenal gland responsiveness Before induction: basal serum total cortisol, free cortisol, and 11beta-deoxycortisol At 6 and 24 hrs after induction of anesthesia: basal serum total cortisol, free cortisol, and 11beta-deoxycortisol followed by a standard high dose (250 ug of synthetic ACTH) Synacthentest, with measurements of total, free cortisol and 11-beta deoxycortisol at 0, 30 and 60 minutes. 4. Inflammatory markers Baseline, 6 and 24 hours: IL6, TNFa | — |
Countries
Netherlands
Outcome results
None listed