• SKin and soft tissue necrotizing INfections in the Intensive Care Unit: a prospective multi-national cohort study
SKin and soft tissue necrotizing INfections in the Intensive Care Unit: a prospective multi-national cohort study
To assess hospital (e., ICU and hospital mortality) and medium-term (day-90 and day-180 mortality, functional outcomes and health-related quality of life scores) outcomes..
To report the clinical presentation and microbiological epidemiology of NSTI and identify independent prognostic factors of mortality and altered quality of life.
DESIGN and POPULATION:
Multinational prospective non-interventional cohort study
- Inclusion criteria:
- Age > 18 years
- Non-opposition to participate in the study
- Patient with surgically-confirmed NSTI (i.e., macroscopic appearance of tissue during surgery revealing swollen, dull gray tissues with a thin, brownish exudate with or without necrosis)
- Exclusion criteria: none
STUDY START DATE and REGISTRATION:
The project aims to start in 2021
We wish to involve medical professionals from > 100 ICUs and include 1033 patients
Register your ICU here
MORE INFORMATION and CONTACT:
Nicolas de Prost, M.D., Ph.D., Medical Intensive Care Unit, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France and Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France firstname.lastname@example.org
Members of the Steering Committee:
Olivier Chosidow, M.D., Ph.D., Department of Dermatology, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France. Olivier.email@example.com
Christian Eckmann, M.D., Ph.D., Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Center for Research in Surgicasl Infections, Academic Hospital of Goettingen University, Hannoversch-Muenden, Germany. firstname.lastname@example.org
Martin Bruun Madsen, M.D., Ph.D., Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. email@example.com
Tomas Urbina, M.D., Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. firstname.lastname@example.org
Jan de Waele, M.D., Ph.D., Department of Critical Care Medicine / Surgical Intensive Care Unit, Ghent University Hospital, Gent, Belgium. Jan.DeWaele@UGent.be
We are looking for National Coordinators (NC): Please contact Nicolas De Prost
Download the protocol here
• PRone positioN in patients with spontanEous ventiLation and acute respIratory FailurE
Incidence of intubation at 28 days after randomization in prone position patients with de novo acute hypoxemic respiratory failure under high flow nasal oxygen.
In patients with acute hypoxemic de novo respiratory failure under high flow nasal oxygen, we want to determine the effects of prone position on:
- PaO2/FiO2 and SpO2/FiO2 within the first 48 hours
- Days under HFNC
- ICU and hospital LOS
- 28 and 90-day mortality
- Serious adverse events during PP or unproning
- Composite outcome, any of the following included:
o Oxygen desaturations (SpO2 <90%)
o Episodes of hemodynamic instability (Systolic arterial pressure < 80 mmHg or heart rate >120 beats per minute)
o Displacement of central venous line, arterial line or urinary catheter if documented.
o At the end of the study, the nurse in charge will be asked to anonymously to judge the safety of the procedure using an analogue scale ranging from 0 (completely unsafe) to 10 (totally safe)
- Comfort, defined according a visual analogue comfort scale
- Dyspnea, defined according Borg dyspnea scale
- Total amount of time the patient could remain in prone position
- Nurse workload: The nurse in charge will be asked to anonymously rate in minutes the additional workload due to the entire procedure (both proning and unproning)
- Feasibility scale: At the end of the study, the nurse in charge will be asked to anonymously judge the feasibility of the procedure using an analogue scale ranging from 0 (completely unfeasible) to 10 (totally feasible)
Randomized prospective, open label, two arm, not blinded multicentre controlled trial.
Patients with acute hypoxemic de novo non-hypercapnic respiratory failure. COVID-19 status of patients will be taken into account and analysed in the study in order to find any differences in the primary and secondary outcomes between COVID-19 and non-COVID-19 patients.
COVID-19 infection will be diagnosed if the patient has a confirmed reverse transcriptase-polymerase chain reaction (RT-PCR).
The total trial duration will be 36 months. The total recruitment period will last for 1 year with a follow up of 3 months, based on a recruitment rate of 75% for each centre. There will be 3 months at the end for final data analysis, reporting and trial close down.
Study start date and Registration
The project aims to start in 2021.
We wish to involve medical professionals from 40 ICUs and 678 patients.
Principal Investigator – Contact
Luis Fernando Morales-Quinteros
Sagrat Cor University Hospital, Barcelona, Spain
Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain email@example.com
Massimo Antonelli, Antonio Artigas,Marta Camprubi-Rimblas,
Candelaria de Haro, Raquel Herrero, Nicole Juffermans, Domenico Luca Grieco
Download the protocol here
• Toxic-Europe. The Outcome of Intoxicated ICU Patients in Europe
Patients with serious intoxications are admitted to the ICU for surveillance, because the time of maximum toxicity is often difficult to predict. However most patients admitted for an intoxication in the ICU have a short duration of stay and a low mortality compared to other ICU patients. The TOXIC-Europe study will provide new insights in early triage of patients with severe intoxications that could lead to more efficient care at ICUs.
To assess the incidence, severity and clinical consequence of patients with acute intoxications at intensive care units (ICU) in Europe.
International, multicentre, prospective, observational cohort study.
ICU adult patients admitted from an emergency room (ER) or ward with an acute intoxication as primary reason of admission and an ICU stay of more than 4 hours.
To describe current rates of eventful admission defined as having received intensive treatment within 24 hours after ICU admission with patient and intoxication characteristics.
To describe complications, length of ICU and hospital stay, length of treatment, time to limitation of first life sustaining treatment and in-hospital or 30-day mortality.
To assess current clinical practice of handling acute intoxications, treatment decisions and their relation to outcome across geographical regions.
To identify early predictors of outcome including intoxication specific indicators such as ECG factors for cardiovascular toxicities.
To develop a prognostic model that predicts a complicated course for patients with an acute intoxication.
Study start date and Registration
The project started in 2020 and site recruitment is open. We welcome more sites to join the study. You can register your ICU at our website: https://toxicstudy.org/
We are looking for National Coordinators
We call out for national coordinators to support the conduct of TOXIC-Europe within their country. You can register at our website: https://toxicstudy.org/
Dylan de Lange
Barbara Borgatta (also National Coordinator for the UK)
Hans Flaatten (also National Coordinator for Norway)
Christian Jung (also National Coordinator for Germany)
Bruno Mégarbane (also National Coordinator for France)
Rui Moreno (also National Coordinator for Portugal)
Phone: +31 88-755 8561
More information including the study protocol and ethical essessment(s) can be found at https://toxicstudy.org/
• Corona Virus disease (COVID19) in Very Elderly Intensive care Patients (VIPs): COVIP study
The COVID-19 pandemic is threatining numerous countries worldwide. Preliminary reports of critically ill COVID-19 patients in Wuhan (China) and Italy reported a high risk of death in patients with multimorbidity. Also, very old patients with SARS-CoV-2 infections suffered from high mortality rates (1). It is, however, unclear if age alone is an independent risk factor, or if co-morbid conditions and frailty trigger the adverse outcome. During the pandemic, treating and triaging elderly COVID-19 may challenge our health care systems.
COVIP study is a European multicenter study of outcomes and prognostic factors in coronavirus disease (COVID-19) in very old intensive care patients. This international, multicenter study group (VIP-network) will conduct a prospective, observational study to examine the relationship between age, co-morbidities, pretreatment frailty and outcomes in a group of elderly patients receiving critical care for COVID-19.
The coronavirus SARS-CoV-2 is currently affecting thousands of patients across many countries and there is an urgent need to investigate patient characteristics and outcome trajectories.
The VIP network which has previously (2016-2019) conducted the most extensive prospective studies (VIP1, VIP2) on elderly ICU patients, is immediately deploying this study of elderly COVID19 patients.
The results will be essential to understand which factors can predict mortality in elderly COVID-19 patients to help to detect these patients early. Furthermore, this study will also be a knowledge base necessary to guide triage decisions in the future.
Register your ICU:
Click to register your ICU here
Please check the following website: https://vipstudy.org/
(1) Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020.
• Multicenter ObserVational Study on PracticE of VeNTilation In Brain Injured PAtIeNts: VENTIBRAIN
Several experimental and clinical studies have shown how brain injury can cause secondary lung injury. Lung injury could be due either to mechanical ventilation- often necessary in brain injured patients- or to inflammatory response that follows primary acute brain injury. The concept of ‘Protective lung ventilation’ has shown to reduce morbidity and mortality of intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS) but seems also to have a beneficial effect on patients with healthy lungs and in the perioperative settings. However, these recommendations often come into conflict with the management of patients affected by acute brain injury, in which permissive hypercapnia and increased intrathoracic pressure as consequence of protective ventilation strategies can be dangerous.
This observational study aims to determine the ventilation practice of consecutive intubated and ventilated neuro-ICU patients in the first week from admission in intensive care units.
1. Primary objective is to determine ventilation settings of intubated and mechanically ventilated neurocritically ill patients admitted to the ICU.
2. Secondary objectives are:
- The association of ventilator settings and targets with outcome in the whole population
- The differences in ventilator settings among different countries
- To assess the incidence of pulmonary complications (including pneumonia, ARDS, neurogenic pulmonary edema) in this cohort of patients.
- To assess the ventilator settings applied when intracranial pressure is raised (>20 mmHg).
This is an international multi–center prospective observational study.
This study will include all consecutive brain injured patients (traumatic brain injury (TBI) or cerebrovascular) intubated and ventilated in ICU and observed for a 7–day period.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness:
Seen the observational design of the study, there is no patient burden. Collection of data from ICU and hospital charts and/or (electronic) medical records systems is of no risk to patients.
Documents for applying to the Ethical committee will be provided in few months.
Please check IRB/ethical committee approval process locally.
Participation and contact:
Core Steering Committee:
Chiara Robba (Principal Investigator)
Extended Steering Committee :
Rafael Badenes (NC Spain)
Valentina Della Torre (NC UK)
Ary Serpa Neto
Raphael Cinotti (NC France)
• International Point Prevalence Study of Intensive Care Unit Transfusion Practices –InPUT study
For the InPUT study, an international point prevalence study on transfusion practice on ICUs, we are looking for participating centres and national coordinators
Content InPUT study:
Study population: All patients ≥ 18 years, admitted in a pre-specified week.
- Baseline characteristics
- Daily until ICU discharge (with a maximum of 28 days)
- For each transfusion event until ICU discharge (with a maximum of 28 days)
- 28 day mortality
Primary outcome: Number of red blood cell, platelet, and coagulation factors in relation to haemoglobin levels, platelet count and INR/PT.
Data entry: Online platform in REDCAP
Please read study protocol and the publication of the pilot feasibility study (https://www.sciencedirect.com/science/article/pii/S1246782019304379) for more information.
We provide authorship to all national coordinators and when allowed by the journal also for the local PIs. If not allowed we will mention them as collaboration partner which results in a Pubmed citation. Furthermore, participating centers are allowed to do additional studies on the data set. The steering committee will coordinate these additional research questions and additional analysis.
Tasks of national coordinators:
- Recruit and coordinate with centers within your country
- Ask for waiver or ethical approval at your IRB
Currently we have national coordinators in the following countries:
|Croatia||India||Pakistan||South-Afrika||United Arab Emirates|
|Czech Republic||Iran||Poland||Spain||United States|
Coordinating investigator: Sanne de Bruin
International principal investigator: Alexander Vlaar
If you have any questions and/or you are interested in participation, please contact us on firstname.lastname@example.org
• Prospective multicenter Observational study on Transfusion practice in vv-ECMO Patients: The PROTECMO Study
What and Why?
The PROTECMO study will provide new insights on the topic of transfusion management of critically ill patients undergoing VV-ECMO.
The optimal management of anticoagulation targets and transfusion practice in veno-venous-ECMO (VV-ECMO) patients is still under debate. Traditionally, the threshold for transfusions of packed red blood cells (PRBC) in ECMO is aimed at keeping hemoglobin (Hb) values in the normal range (12-14 g/dL), but some case series have shown how the Hb target can be lower, and with comparable clinical outcomes.
Recently, in the EOLIA trial, which enrolled patients from 2011 to 2017, the Hb level was set per protocol between 8 and 10 g/dl (with a planned possible increase in the case of persistent hypoxemia), far from the level recommended in the CESAR trial (protocolized between 12 and 14 g/dl), which included patients ten years before.
PROTECMO will highlight what blood products out ECMO patients receive, how and when they are administered in the current evolving equipment scenario for ECMO.
The principal aim is to describe current effective blood product usage, during VV-ECMO. The secondary aim is to describe in a large cohort of ECMO patients the current anticoagulation strategy and bleeding episodes occurrence.
The study is designed as a prospective observational multicenter cohort study.
No intervention. No additional tests. All data to be collected from the patient’s file and just data adopted in the current practice of each ECMO center will be recorded.
The data collection will include pre-ECMO characteristics, transfusion strategies and blood test results during the first twenty-eight days after ECMO cannulation or until the end of ECMO support if the length is shorter, and clinical outcomes up to the end of ICU stay.
Inclusion criteria/patient selection
All patients who receive extracorporeal lung support (ECMO) for ARDS respiratory causes will be included. Of note, considering the observational design of our study, patients can be included in other studies concurrently (this will be noted on the CRF).
Exclusion criteria: refusal to include
Jehovah’s witnesses and all patients refusing transfusions for personal reasons will not be excluded, but they will be analyzed separately.
COVID-19 : Report as diagnosis instead of viral pneumonia. The investigator can select “other acute respiratory diagnosis” and specify COVID-19
Duration of the study
12 consecutive months or 20 consecutive VV-ECMO runs per intensive care unit, whichever comes first.
A flexible start of the inclusion period will be allowed for each ICU to facilitate participation in the study. Enrollment of ICU will last until the end of March 2019.
Do I need IRB approval?
Ethical requirements for data collection vary within countries and jurisdictions. Where appropriate, ethical approval and requirement or waiver for consent of participation will be obtained for each country by the country coordinator and where required by the local primary investigator at each site.
The promoting center, IRCCS-ISMETT, based on the Italian Privacy code will ask to relatives and informed consent for the participation in the study and for data protection. The study coordinator may provide a template in English for these consents.
All data will be reported in a centralized online and Web-based fully encrypted database (REDCAP). The study coordinator will regularly contact the local PI to ensure data collection and reporting as well as completion of patient follow-up.
Is there any financial compensation?I
No. Participation in the trial is completely voluntary. In every center 2 investigators will be listed as collaborators; some of the national coordinators, according to the entity of data and type of journal will be listed as authors. The multifaceted aspect of this prospective study will allow probably the publication of more than one manuscript and will give the opportunity for a larger involvements of the investigators.
How do I participate?
We are calling for ICUs from all over the world and we are seeking national coordinators. Express your interest sending an email and you will be contacted for center recruitment form.
The project has not received any external financial support and is currently supported by IRCCS-ISMETT.
- Antonio Arcadipane, Gennaro Martucci (IRCCS-ISMETT, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione, Palermo – Italy)
- Antonio Pesenti, Giacomo Grasselli (University of Milan)
- Daniel Brodie (Columbia University, New York)
- Hergen Buscher (St. Vincent’s Hospital, Sydney, Australia)
- Giuseppe Foti (University of Monza)
- Marco Ranieri (University of Rome)
- Peter Schellongowski (University of Vienna)
- Matthieu Schmidt (University of Paris)
- Kenichi Tanaka (University of Maryland)
National Coordinators (Ongoing selection)
- Italy: G. Panarello, Palermo
- Spain and South America: J. Riera, Barcelona
- France: M. Schmidt, Paris
- Austria: P. Scellongowski, Vienna
- UK: A. Retter, London
- Australia, New Zeland, Asia: H. Buscher, Sydney
CENTERS IN PREPARATION FOR ETHIC COMMITTEE APROVAL
- Maastricht University Hospital
- Charité – Berlin
- Apollo Hospital – Bangalore
- Hospital Sacre-Coeur – Montreal
- Seoul National Univerity Bundang Hospital
- Mater Domini, University Hospital – Catanzaro
- LSU Health Sciences Center-Shreveport
- Hospital UniversitarioRamon y Cajal – Madrid
- Hospital Universitario Son Espases – Palma de Maiorca
- Hospital Clinico Universitario – Murcia
- St. Vincent’s Hospital – Sydney
- Mercy Hospital St. Louis
- Clínica Bazterrica, Argentina
- Hospital Universitario Marqués de Valdecilla – Santander
- HOSPITAL UNIVERSITARIO VIRGEN DEL ROCIO
- Saiseikai utsunomiya hospital
- Tokyo Metropolitan Tama Medical Center
- Pusan National University Yangsan Hospital
- Chonbuk National University Medical School
- Chiba University Hospital
- CHRU Lille, Hôpital Roger Salengro
- Zhujiang Hospital, Southern Medical University, China
- University Hospital in Krakow
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico city
- Upstate University Hospital
- OHSU, Oregon
- National University Hospital, Singapore
- University of Leuven
- Centre Hospitalier Liege
- University of Sao Paulo
- Instituto do Coração, São Paulo
- Papworth Hospital
• SQUEEZE, a prospective multi-centre international observational study of postoperative vasopressor usage
Initiated in the ESICM POIC Section, this is a European Society of Anaesthesiology Clinical Trial Network (ESA CTN) sponsored study and it has been endorsed by ESICM.
Dr. Ib JAMMER (Haukeland University Hospital – Bergen, Norway)
Dr. Ben Creagh-Brown (Royal Surrey County Hospital NHS Foundation Trust – Guidlford, United Kingdom)
Download the study flyer here
In the era of goal-directed fluid therapy and increasing popularity of restrictive fluid resuscitation, patients may be receiving less intravenous fluid and receiving more infused vasopressors to maintain adequate blood pressure.
There is anecdotal evidence of substantial variation in the management of post-operative hypotension between centres, countries and continents. The variation is in assessment (cardiac output and invasive monitoring) and environment (post-operative care units, high-dependency units, ICUs) and management (use and choice of fluids and vasopressors/inotropes).
In critically ill populations, receipt of infused vasopressors is associated with organ dysfunction, it has not been established if this relationship is true in postoperative populations.
To evaluate the proportion of non-cardiac surgical patients receiving postoperative vasopressors.
To evaluate the characteristics of patients, surgery and anaesthesia that lead to postoperative vasopressor use.
To evaluate the incidence of organ injury in patients who receive postoperative vasopressors
To evaluate the variability in postoperative vasopressor use across healthcare environments.
Incidence of vasopressor use, and elucidation of risk factors
Postoperative organ dysfunction in patients receiving infused vasopressors.
Study selected by ESA Research Committee: April 2018
Call for centres: Ongoing
Finalizing protocol: Autumn 2018
Recruitment of patients: foreseen for Autumn 2019
How do I participate?
This study will recruit as many participating institutions as possible across the 30 European countries represented at the ESA Council. It is plan to recruit at least 40,000 patients.
Would your hospital like to join this study as an actively contributing research centre? The ‘Call for Centres form’ must be filled in online. The completion of this form will facilitate the coordination and is mandatory for participation in ESA CTN. The ESA Secretariat will contact you to provide you with additional information. Please visit the call for centres page.
Ib Jammer (Norway), Ben Creagh-Brown (UK), Lui Forni (UK), Ramani Moonesinghe (UK) and Hannah Wunsch (Canada).
National Coordinating Investigators: The ESA Secretariat and Steering Committee are looking for National Coordinating Investigators to support the conduction of SQUEEZE study, if you are interested, please contact it at SQUEEZE@esahq.org.
• Extubation strategies in Neuro-ICU patients and associations with outcomes – ENIO
The ENIO study is an international observational study, about the practices of the mechanical ventilation weaning processes in patients hospitalised in the ICU with a severe brain-injury (trauma, haemorrhage, stroke…). The study will focus on extubation and/or tracheostomy. One of the primary target is to identify factors of extubation success in these patients and delineate the consequences on outcomes, which will be collected in the ICU and at hospital discharge.
The goal is to recruit at least 60 centres worldwide in order to include 1500 patients with extubation and/or tracheostomy. Each centre is expected to include at least 20 patients with extubation and/or tracheostomy over a 6-month period.
Contact: Raphael Cinotti
• EURopean study on Encephalitis in intensive Care – the EURECA Study
This is a prospective observational multicentre study in European ICUs. All patients admitted to the ICU for probable or confirmed AE (2013 IDSA criteria) will be included. The target is 1000 patients admitted to the ICU for AE (5 consecutive patients in each participating ICU, targeted number of ICUs in Europe: 200)
Acute encephalitis (AE) is a severe neurological disorder associated with significant morbidity and mortality. Approximately 60% of patients with AE require ICU admission because of coma, seizures or acute respiratory failure. Determinants of neurological prognosis of these patients are not known.
The main aims of the project are to describe the epidemiology and outcomes of patients admitted to the ICU with all-cause acute (meningo-) encephalitis in European countries. Specifically, we aim to identify early indicators of poor neurologic outcome in this population and to identify challenges in the management in the ICU, namely: temperature management, neuromonitoring, seizure management, specific therapy (antibiotic therapy, steroids, IVIg..)
For more information, download the protocol.
This project won the ESICM Established Investigator Award 2017.
Contact: Romain SONNEVILLE – Bichat Claude Bernard University Hospital
• VIP2 Very old Intensive Care Patient-study 2: Development and validation of a prognostic score
This study will seek to develop a prognostic score based on a large prospective multicentre study of the critically ill very old, defined as patients ≥ 80 years, emergency admitted to an ICU. We will gather age-specific information about the elderly patient: frailty, cognitive function, activity of daily life and co-morbidity, in addition to organ failure score. Outcomes will be registered as outcome at 30 days (alive or dead) and 6 months in a sub study. Also an inter-rater variability will be registered in a sub-study within the main study.
Recruitment: ICU recruitment took place from the fall of 2017 until fall of 2018 and is now closed.
More information at www.vip2study.com
Contact: Hans Flaatten
This project won the ESICM Clinical Research Award 2017
Follow up of VIP1 study:
• iCareWean “Weaning from mechanical ventilation: comparison of open-loop decision support system and routine care, in general medical ICU”
The BEACON care system is an open-loop decision support device that works alongside current ventilator systems in the intensive care unit. BEACON utilises physiological measurements, available at the bedside, and integrates them through a series of linked mathematical models. BEACON then uses these models to provide advice as to the ventilator setting that best optimises the patient’s individual physiological requirements.
- Single-blinded RCT
- ICU patients undergoing mechanical ventilation across both Chelsea & Westminster Hospital and West Middlesex Hospital.
- Recruiting 275 participants in total across the two sites.
- Ventilator management determined by the BEACON Caresystem versus standard ventilator management.
- The primary outcome: Time on mechanical ventilation.
See protocol flowchart.
More information about the study is available here.
REC reference: 17/LO/0887; IRAS Project ID: 226610; HRA: NIHRA under review; Clinicaltrials.gov Registered; ESICM endorsement
• PROTECTION: PRessuresuppOrTvEntilation + sigh in aCuTehypoxemIcrespiratOry failure patieNts
This study, initiated within the ESICM PLUG (Pleural Pressure) Working Group, is a randomised controlled (RCT) on the effects of short cyclic recruitment maneuver (Sigh) added to pressure support ventilation (PSV) that will be conducted in several ICUs in different countries.
More information about the primary/secondary endpoints and on the inclusion and exclusion criteria available in the protocol here.
How do I participate?
Interested sites can contact Tommaso Mauri
Study Start Date
Tommaso Mauri, University of Milan and Ospedale Maggiore Policlinico, Milan, Italy
Laurent Brochard, Medical and Surgical Intensive Care Unit, Saint Michael’s Hospital, Toronto, Canada
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Tommaso Mauri, Laurent Brochard, Jean-Michel Constantin, Giuseppe Foti, Claude Guerin, Jordi Mancebo, Paolo Pelosi, Marco Ranieri, Antonio Pesenti.
Carla Fornari and Sara Conti, University of Milan-Bicocca, Monza, Italy
Contact: Tommaso Mauri
• STARRT-AKI: STandard versus Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury
To determine whether, in critically ill patients with severe acute kidney injury (AKI), a strategy of accelerated (early) initiation of renal replacement therapy (RRT), compared to a standard (delayed) strategy for initiation of RRT contributes to improved 90-day survival and recovery of kidney function.
Multi-national, multicentre, open-label, randomised, controlled trial. The trial is currently enrolling participants in 6 countries at 44 sites. The trial anticipates a total of 14 countries and approximately 100 sites.
2,866 critically ill patients with evidence of severe AKI who do not have an urgent indication for initiation of RRT at the time of screening but who have a reasonable likelihood of ultimately requiring RRT.
Inclusion (all must be fulfilled):
1) age ≥ 18 years;
2) admission to intensive care unit (ICU);
3) evidence of kidney dysfunction (serum creatinine ≥100 µmol/L in women and ≥130 µmol/L in men;
4) evidence of severe AKI defined by 1 of the following: i) 2-fold increase in serum creatinine from known baseline or during current hospitalization; or ii) achievement of a serum creatinine ≥354 µmol/L with evidence of a minimum increase of 27 µmol/L from premorbid baseline or during current hospitalization; or iii) urine output <6 mL/kg over the preceding 12 hours.
Exclusion (any of the following results in ineligibility):
1) serum potassium >5.5 mmol/L;
2) serum bicarbonate <15 mmol/L;
3) presence of a drug overdose necessitating urgent RRT;
4) lack of commitment of ongoing life support (including RRT);
5) any RRT within prior 2 months;
6) kidney transplant in preceding 1 year;
7) known advanced chronic kidney disease (CKD) defined by eGFR<20 mL/min/1.73m2;
8) presence or suspicion of renal obstruction, acute glomerulonephritis, vasculitis, thrombotic microangiopathy or acute interstitial nephritis;
9) clinician(s) caring for patient believe that immediate RRT is absolutely mandated;
10) clinician(s) caring for the patient believe that deferral of RRT is mandated.
1) Accelerated (early) RRT initiation (experimental arm): a dialysis catheter will be placed and RRT initiated within 12 hours of the patient becoming fully eligible;
2) Standard (delayed) RRT initiation (control arm): In the absence of kidney function recovery, RRT initiation will be permitted if one or more of the following criteria develop: 1) serum potassium ≥ 6.0 mmol/L; 2) pH ≤7.20 or serum bicarbonate ≤12 mmol/L; 3) hypoxemic respiratory failure, based on P/F ratio ≤ 200 and clinician perception of volume overload; and/or 4) persistent AKI >72 hours following randomisation. Once criteria are fulfilled and/or a decision is made to initiation RRT, a dialysis catheter will be placed and RRT started as soon as possible. There is no obligation to start RRT in the standard arm. All other aspects of RRT (i.e., modality, dose, anticoagulation etc.) for both arms will follow current best practice and local standards.
All-cause mortality at 90-days.
RRT dependence at 90-days; composite of death/RRT dependence at 90-days; major adverse kidney events (MAKE) at 90-days; ventilator-free days through day 28; ICU-free days through day-28; hospital-free days through day-90; death in ICU, 28-days, in-hospital and 1-year; health-related quality-of-life (EQ-5D-5L) at 90-days and 1-year; healthcare costs and incremental cost-effectiveness ratio through 1-year.
Analysis: Primary analysis will follow the principle of intention-to-treat.
Start date: Active.
Duration: 36 months
Estimated completion study date: December 2019
How do I participate?
To participate, please contact Sean M Bagshaw and Ron Wald (Co-Principal Investigators) from the Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Canada) Email: email@example.com and firstname.lastname@example.org
• International Study on NoSocomial Pneumonia in Intensive CaRE – The PneumoINSPIRE study
Head investigator: Despoina Koulenti, 2nd Critical Care Department, Attikon University Hospital, Athens (Greece); Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland (Australia)
Project start date
The project has started. However, site recruitment is still open and we welcome more sites to join the study. New sites may register and join the study at any time during 2016.
Initiated by the working group on Pneumonia of the ESICM INF Section, the aim of this project is to perform an international multicentre prospective observational cohort study of nosocomial pneumonia in intensive care units (ICUs) worldwide in order to provide up-to-date and comprehensive descriptive data on the diagnosis, microbiology, time course of resolution, management and outcomes in a global ICU population.
– Evaluate the global epidemiology of nosocomial pneumonia in ICU patients, analysing responsible pathogens and resistance pattern by type of pneumonia and geographical region.
-Describe current clinical practice regarding diagnosis and determine the degree of concordance between the diagnosis of nosocomial pneumonia in routine clinical practise and official definitions, including: a) ATS/IDSA 2005 guidelines; b) CDC/NHSN Surveillance Definitions, 2015.
-Identify variable treatment decisions with emphasis on therapeutic schemas, appropriateness and de-escalation decisions and their relation to outcomes.
– Evaluate time course of resolution and identify early predictors of outcome in a large cohort.
– Evaluate nosocomial pneumonia in specific subgroups of critically ill patients (such as, chronic obstructive pulmonary disease [COPD], the elderly, and trauma patients).
– Describe the differences of nosocomial that develop in non-intubated ICU patients versus ventilator-associated pneumonia (VAP).
– Compare the characteristics and outcomes of nosocomial pneumonia in ward patients (that due to deterioration are later on transferred to the ICU) with nosocomial pneumonia in non-intubated ICU patients.
Site selection & population
All ICUs can apply for participation in the PneumoINSPIRE study with consideration to the following requirements: (i) ICUs must agree to collect unit and patient related data onsite; (ii) ICUs agree to transfer the collected data to the coordinating centre; (iii) ICUs must pursue and obtain ethics committee approval or a waiver.
Participating ICUs will collect data from a nominated start date until a minimum pre-specified target of 10 ICU patients with nosocomial pneumonia is reached. The participating ICUs will be allowed to continue recruitment after they have reached the minimum target of 10 patients if they wish to do so, provided that recruitment period of the study is still open.
2016 until December 2017
Contact: Despoina Koulenti
ClinicalTrials.gov Identifier # NCT02793141
• iSOFA – Intestinal-Specific Organ Function Assessment
Lead Investigator: Annika Reintam Blaser, Dept. of Anaesthesiology and Intensive Care, University Of Tartu, Estonia and Center of Intensive Care Medicine, Lucerne Cantonal Hospital (CH) and Martin Poeze, Maastricht University Medical Center, Dept of Surgery/Intensive Care Medicine (NL).
Project Dates: October 2014 – March 2018
Part A: To prospectively evaluate the value of gastrointestinal symptoms alone and in combination with intra-abdominal pressure (IAP), and acute gastrointestinal injury (AGI) grades, as defined by the ESICM Working Group on Abdominal Problems, in prediction of outcome in intensive care patients.
Part B: To determine whether biochemical markers (plasma and urine) of intestinal injury are of additional prognostic value compared to clinical gastro-intestinal symptoms and AGI grades.
The general aim of the project is to develop a five grade score (0-4 points) for assessment of GI function similar to SOFA sub-scores used for assessment of other organ systems.
More info: contact Anika Reintam