An interventional study of ultrasound for microcirculatory assessment in Critical Illness and Septic Shock, sponsored by St. Olavs Hospital. Terminated at 1 site in Norway. Open to participants aged 20 Years to 60 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2020-09-18.
Sponsored by St. Olavs Hospital · Not applicable, Interventional, and Diagnostic
Aim of this study is (1) to test and further develop a new non-invasive ultrasound method, and (2) to gain new insight into microcirculatory alterations during critical disease, particularly in critical septic shock patients.
Although early identification and treatment of sepsis have had top priority among the working tasks of the international 'Surviving Sepsis Campaign' society (collaboration of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine) for several years, which have led to improved survival over the last two decades, there is no objective validated diagnostic test to identify or to support the clinical diagnosis at an early stage. Analogous, there is no validated monitoring system available to guide and evaluate the effects of stabilizing measurements in sepsis, or other critical disease, at the microcirculatory level. And thus, there is an enormous knowledge gap regarding dynamic changes at the microcirculatory level during sepsis and other critical disease.
Goal with this study is to investigate the robustness of this new US-technology, regarding its ability to identify and monitor critical microcirculatory impairment during critical disease. The investigators believe this technology may improve early diagnosis and thus early initiation of adequate treatment in septic shock. Its mobile and non-invasive qualities, as in most ultrasound methods, substantiate its availability to a wide range of clinical settings.
Critical disease, e.g. life threatening septic shock triggered from infections with multiorgan failure, demands aggressive medical treatment in specialized intensive care units (ICU). Incidences and mortality of sepsis vary significant, depending on regional medical culture, diagnostic criteria and the time span and method of data collection.
Common clinical appearance of critical disease is often life threatening low blood pressure, impaired consciousness up to coma, abnormal breathing patterns, and then subsequently secondary organ failures which further increases mortality. The influence of these 'macro-haemodynamic symptoms', i.e. physiologic aberrations that can be assessed using standard patient monitoring systems, on the tissue micro-circulation where organ damage and finally cell death occurs, is only indirectly available for assessment. Basically, the coarse therapeutic approach to circulatory shock is to normalize macro-haemodynamic parameters, without any robust method to evaluate and monitor micro-circulatory effects. Thus, following current guidelines and clinical practice, it is sometimes not known for sure, on an individual basis, whether treatment and stabilization measures increase survival chances.
Studies of the microcirculation have been performed using invasive micro-dialysis, direct orthogonal polarization spectral imaging and direct side-stream dark-field microscopy. The wide use of these methods is challenged by the fact that they are very expensive and demand extended operator expertise.
The investigators think there is sufficient evidence to claim that further improvement in early diagnostic and therapy guidance of sepsis, septic shock and other critical disease, depends on increased knowledge of microcirculatory alterations, and widespread affordable technical solutions to detect and monitor the course of sepsis and other critical disease at the microcirculatory level.
At the Norwegian University of Technology and Science (NTNU), Department of Circulation and Medical Imaging (ISB), new ultrasound technology has been developed by Professor Hans Torp, which may offer an operator-independent, affordable and non-invasive method to evaluate microcirculation in humans.
In general, ultrasound is unique in that sense that it facilitates non-invasive imaging of anatomy and physiology. The unique with this new probe is the emittance of ultrasound waves from the whole cross-section of the probe surface.
To describe the expected spectrum of microcirculatory impairment during different stages of sepsis, septic shock and comparable critical disease, firstly US registrations are needed from persons with known normal microcirculation. Then, registrations of normal microcirculation are needed in persons exposed to increasing amounts of circulatory stress. Finally, microcirculatory conditions will be observed in patients with critical septic shock. Thus, firstly healthy volunteers are included, then stabile patients undergoing major planned surgery, and finally patients in critical septic shock demanding advanced intensive care treatment and monitoring.
1,078 studies on the registry are indexed under Shock, Septic; 232 are open to participants now.
This study's enrollment of 30 is below the median of 79 across 636 interventional studies indexed under Shock, Septic.
Browse Shock, Septic studies →St. Olavs Hospital is the lead sponsor of 171 studies on the registry; 29 are open to participants now.
Compared within Shock, Septic, this study's primary condition as ClinicalTrials.gg classifies it; the registry's first condition term is Critical Illness. The counts are of registry records indexed under each term, refreshed daily. How we classify →
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Weight in kilograms divided by height in metres squared. Example: 70 kg and 1.75 m gives 70 ÷ (1.75 × 1.75) ≈ 22.9.
What counts as overweight or obesity differs between countries (some use lower cut-offs), so go by the range the study states.
BMI (body mass index)
Weight in kilograms divided by height in metres squared. Example: 70 kg and 1.75 m gives 70 ÷ (1.75 × 1.75) ≈ 22.9.
What counts as overweight or obesity differs between countries (some use lower cut-offs), so go by the range the study states.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
10 patients. ultrasound for microcirculatory assessment applied.
Device: ultrasound for microcirculatory assessment
10 patients. ultrasound for microcirculatory assessment applied.
Device: ultrasound for microcirculatory assessment
20 patients. ultrasound for microcirculatory assessment applied.
Device: ultrasound for microcirculatory assessment
10 subjects. ultrasound for microcirculatory assessment applied.
Device: ultrasound for microcirculatory assessment
Ultrasound for microcirculatory assessment Repeated measurements within study participants for analysis of variance and explorative analyses of ultrasound signals, to identify most suitable parameters to describe microcirculatory alterations in critical disease, especially in sepsis. Analyse blood flow velocities in several depths and from several vessels of different sizes simultaneously US registration repeated within each study participant consecutively on seven different regions of the body surface.
Pulsatile index
(velocity max - velocity min) / mean velocity
Time frame: 1 day
Time-velocity-integral
Time frame: 1 day
Ran from Oct 2017 to primary completion in Nov 2019, 24 months.
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This study is terminated, as verified in Sep 2020. You cannot join it, but the record below documents what was studied.
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