The Effect of Dexmedetomidine on Microcirculation in Severe Sepsis
Status:
Terminated
Trial end date:
2018-02-24
Target enrollment:
Participant gender:
Summary
Despite early goal-directed maintenance of normal macrocirculation, the reduction of 60-day
mortality of patients with severe sepsis and septic shock remained unsatisfied (56.9% to
44.3%). One of the major causes of high mortality is microcirculatory dysfunction. Delayed
diagnosis and treatment of microcirculatory dysfunction may cause tissue hypoperfusion and
resulted in multiple organ dysfunction and death. Dexmedetomidine is a highly selective
α2-adrenoreceptor agonist which exhibits sedative and analgesic effects. Recent studies
suggest that dexmedetomidine also has anti-coagulation and anti-inflammatory effects, and it
can reduce the mortality of endotoxemic rats and patients with severe sepsis. The
investigators will conduct two animal studies and one clinical trial to investigate the
effect of dexmedetomidine on microcirculatory dysfunction and organ injury in rat with
endotoxemia and patients with severe sepsis and septic shock.
Sixty patients with severe sepsis and septic shock will be enrolled and randomized to control
group or dexmedetomidine group. In the control group, the patients will be treated according
to the clinical practice guideline. If sedation is required, non-dexmedetomidine sedative
agents will be used. In the dexmedetomidine group, the patients will be treated according to
the clinical practice guideline, and they will also receive continuous infusion of
dexmedetomidine (infusion rate ranged from 0.1 to 0.7 mcg/kg/h) for 24 hours as needed. The
sublingual microcirculation, serum level of Endocan, NGAL(Neutrophil Gelatinase-Associated
Lipocalin), and BNP(B-type natriuretic peptide) will be examined at preset time points up to
24 hours. The vital signs, hemodynamic parameters, and survival of 28-day and 90-day will be
recorded and analyzed.