Trial of Steroids in Pediatric Acute Lung Injury/ARDS (SPALIT)
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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are devastating disorders associated with lung inflammation, low oxygen levels and respiratory failure in children. Prevalence of ALI ranges from 2.2 to 12 per 100,000 children per year. Using these estimates, up to 9,000 children each year will develop ALI/ARDS, which may cause upto 2,000 deaths per year. Currently, there are no specific therapies directed against ARDS/ALI in children. In adult patients, use of steroids early in the course of ARDS appears promising. There are no published clinical trials examining the use of steroids for the treatment of ALI/ARDS in children.
Hypothesis:
Subjects with ALI/ARDS receiving steroids early in the course of disease (within 72 hours) and longer than 7 days will have improved clinical outcomes as compared to placebo control group as defined by (a) a decreased duration of mechanical ventilation and (b) significantly increased PaO2/FiO2 ratios.
Condition | Intervention | Phase |
---|---|---|
Acute Respiratory Distress Syndrome (ARDS) Acute Lung Injury (ALI) |
Drug: methylprednisolone Drug: Normal Saline (0.9%) |
Phase 2 |
Study Type: | Interventional |
Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
Official Title: | Steroids in Pediatric Acute Lung Injury/ARDS Trial: A Blinded, Placebo-controlled, Randomized Clinical Trial |
- Duration of mechanical ventilation [ Time Frame: 0-28 days ] [ Designated as safety issue: No ]Number of hours required for positive pressure ventilation after the start of study drug
- Improvement in oxygenation [ Time Frame: 0-28 days ] [ Designated as safety issue: No ]Differences in the PaO2/FiO2 ratios between the two randomized groups
- Incidence of nosocomial infections [ Time Frame: 0-35 days ] [ Designated as safety issue: Yes ]Infection surveillance will be in the form of tracheal aspirate for gram stain and culture done prior to study entry and then every 3-5 days. If a subject spikes a fever during the study drug infusion, they will have blood, urine and tracheal aspirate cultures done along with CBC and CRP. Number of nosocomial infections documented via surveillance cultures will be compared between groups.
- Incidence of hyperglycemia [ Time Frame: 0-28 days ] [ Designated as safety issue: Yes ]Number of times that the subject has a Blood Glucose >180 mg/dL (10 mmol/L) will be compared between the randomized groups
Estimated Enrollment: | 100 |
Study Start Date: | October 2010 |
Estimated Study Completion Date: | December 2012 |
Estimated Primary Completion Date: | December 2011 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
---|---|
Active Comparator: Experimental Group
Intervention: Subjects in this study group will receive a loading dose of methylprednisolone 2mg/kg followed by 1mg/kg/day of methylprednisolone infusion from day 1 to day 7; 0.5mg/kg/d from days 8 to 10, 0.25mg/kg/d on days 11 and 12, 0.125mg/kg/d on days 13 and 14. The study drug infusion will be discontinued after 14 days.
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Drug: methylprednisolone
Subjects in this group will receive a loading dose of methylprednisolone 2mg/kg followed by 1mg/kg/day of methylprednisolone infusion from day 1 to day 7; 0.5mg/kg/d from days 8 to 10, 0.25mg/kg/d on days 11 and 12, 0.125mg/kg/d on days 13 and 14. The study drug infusion will be discontinued after 14 days.
|
Placebo Comparator: Placebo Group
Intervention: The placebo will be 0.9% (normal) saline and the active medication will be diluted in 0.9% (normal) saline. The placebo group with receive the masked study drug in infusion rates that mimic the infusions received by the experimental group.
|
Drug: Normal Saline (0.9%)
The placebo will be 0.9% (normal) saline and the active medication will be diluted in 0.9% (normal) saline.
|
Ages Eligible for Study: | 1 Month to 18 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Between 1 month and 18 years of age; AND
Admitted to the PICU with a diagnosis of ALI or ARDS, as defined by:
- acute onset of the disease,
- PaO2/FiO2 ratio <300,
- evidence of bilateral infiltrates on chest radiography, and
- no evidence of cardiac dysfunction; AND
- Intubated and mechanically ventilated.
Exclusion Criteria:
- Underlying disease requiring steroids >0.5mg/kg/day of methylprednisolone (eg. Asthma)
- HIV positive, or have any other congenital or acquired immunodeficiency;
- Terminally ill patients or patients on hospice care or if there is a lack of commitment to aggressive intensive care
- Cytotoxic therapy within the past 3 weeks
- Major gastrointestinal bleeding within last 1 month
- Extensive burns (>20% total body surface area of full- or partial-thickness burns)
- Known or suspected adrenal insufficiency
- Vasculitis or diffuse alveolar hemorrhage
- Bone marrow or lung transplant
- Disseminated fungal infections
- Severe chronic liver disease
- Other conditions with estimated 6-month mortality of 50% or higher
Contact: Bonny Bardhan, M.D. | (734) 731-4486 | bonnybardhan@msn.com |
Contact: Kanwaljeet S. Anand, MBBS, D.Phil. | 901-287-6303 | kanand@uthsc.edu |
United States, Tennessee | |
Le Bonheur Children's Hospital | Recruiting |
Memphis, Tennessee, United States, 38103 | |
Contact: Bonny Bardhan, M.D. (734) 731-4486 bonnybardhan@msn.com | |
Contact: Kanwaljeet S. Anand, MBBS, D.Phil. 901-287-6303 kanand@uthsc.edu | |
Principal Investigator: Bonny Bardhan, M.D. |
No publications provided
Responsible Party: | Kanwaljeet J. S. Anand, MBBS, D.Phil., THE UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER |
ClinicalTrials.gov Identifier: | NCT01274260 History of Changes |
Other Study ID Numbers: | Steroids in Pediatic ALI/ARDS |
Study First Received: | January 9, 2011 |
Last Updated: | July 11, 2011 |
Health Authority: | United States: Institutional Review Board |
Keywords provided by University of Tennessee:
child infant lung injury |
inflammation pneumonia ventilator |
Additional relevant MeSH terms:
Respiratory Distress Syndrome, Newborn Respiratory Distress Syndrome, Adult Acute Lung Injury Lung Injury Lung Diseases Respiratory Tract Diseases Respiration Disorders Infant, Premature, Diseases Infant, Newborn, Diseases Thoracic Injuries Wounds and Injuries Methylprednisolone acetate Prednisolone acetate Methylprednisolone Methylprednisolone Hemisuccinate |
Prednisolone Prednisolone hemisuccinate Prednisolone phosphate Anti-Inflammatory Agents Therapeutic Uses Pharmacologic Actions Antiemetics Autonomic Agents Peripheral Nervous System Agents Physiological Effects of Drugs Central Nervous System Agents Gastrointestinal Agents Neuroprotective Agents Protective Agents Glucocorticoids |
ClinicalTrials.gov processed this record on October 18, 2012