City Research Online

Design of Clinical Trials Evaluating Sedation in Critically Ill Adults Undergoing Mechanical Ventilation

Ward, D. S., Absalom, A. R., Aitken, L. M. ORCID: 0000-0001-5722-9090, Balas, M. C., Brown, D. L., Burry, L., Colantuoni, E., Coursin, D., Devlin, J. W., Dexter, F., Dworkin, R. H., Egan, T. D., Elliott, D., Egerod, I., Flood, P., Fraser, G. L., Girard, T. D., Gozal, D., Hopkins, R. O., Kress, J., Maze, M., Needham, D. M., Pandharipande, P., Riker, R., Sessler, D. I., Shafer, S. L., Shehabi, Y., Spies, C., Sun, L. S., Tung, A. and Urman, R. D. (2021). Design of Clinical Trials Evaluating Sedation in Critically Ill Adults Undergoing Mechanical Ventilation. Critical Care Medicine, doi: 10.1097/ccm.0000000000005049

Abstract

Objectives:
Clinical trials evaluating the safety and effectiveness of sedative medication use in critically ill adults undergoing mechanical ventilation differ considerably in their methodological approach. This heterogeneity impedes the ability to compare results across studies. The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations convened a meeting of multidisciplinary experts to develop recommendations for key methodologic elements of sedation trials in the ICU to help guide academic and industry clinical investigators.

Design:
A 2-day in-person meeting was held in Washington, DC, on March 28–29, 2019, followed by a three-round, online modified Delphi consensus process.

Participants:
Thirty-six participants from academia, industry, and the Food and Drug Administration with expertise in relevant content areas, including two former ICU patients attended the in-person meeting, and the majority completed an online follow-up survey and participated in the modified Delphi process.
Measurements and Main

Results:
The final recommendations were iteratively refined based on the survey results, participants’ reactions to those results, summaries written by panel moderators, and a review of the meeting transcripts made from audio recordings. Fifteen recommendations were developed for study design and conduct, subject enrollment, outcomes, and measurement instruments. Consensus recommendations included obtaining input from ICU survivors and/or their families, ensuring adequate training for personnel using validated instruments for assessments of sedation, pain, and delirium in the ICU environment, and the need for methodological standardization.

Conclusions:
These recommendations are intended to assist researchers in the design, conduct, selection of endpoints, and reporting of clinical trials involving sedative medications and/or sedation protocols for adult ICU patients who require mechanical ventilation. These recommendations should be viewed as a starting point to improve clinical trials and help reduce methodological heterogeneity in future clinical trials.

Publication Type: Article
Additional Information: Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open-access ar-ticle distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. DOI: 10.1097/CCM.0000000000005049
Publisher Keywords: clinical trial; intensive care; outcome assessments; research methodology; sedation
Subjects: R Medicine > R Medicine (General)
Departments: School of Health Sciences
Date Deposited: 14 May 2021 09:20
URI: https://openaccess.city.ac.uk/id/eprint/26144
[img]
Preview
Text - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (559kB) | Preview
[img]
Preview
Text - Supplemental Material
Download (283kB) | Preview

Export

Downloads

Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login