E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Hypovolaemia due to acute blood loss in elective abdominal surgery |
Hypovolémie due à une perte sanguine aiguë dans le cadre d’une chirurgie abdominale non urgente |
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E.1.1.1 | Medical condition in easily understood language |
Decreased blood volume due to acute blood loss during scheduled surgery of the abdomen |
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E.1.1.2 | Therapeutic area | Diseases [C] - Injuries, poisonings, and occupational diseases [C21] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10021137 |
E.1.2 | Term | Hypovolaemia |
E.1.2 | System Organ Class | 10027433 - Metabolism and nutrition disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Investigate the safety and efficacy of a 6% HES 130 versus an electrolyte solution in patients undergoing elective abdominal surgery |
Évaluer la sécurité d’une solution d’HEA 130 à 6 % par comparaison avec une solution électrolytique chez des patients bénéficiant d’une chirurgie abdominale non urgente |
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E.2.2 | Secondary objectives of the trial |
Further investigation of safety and efficacy of the applied products |
Évaluations supplémentaires de la sécurité et de l’efficacité des produits de l’étude administrés |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Male or female adult patients > 40 and ≤ 85 years of age
Women of childbearing potential must test negative on standard pregnancy test (urine or serum)
Patients undergoing elective abdominal surgery with an expected blood loss of ≥ 500 ml
ASA Physical Status II-III
Signed written consent form |
Patients adultes, de sexe masculin ou féminin, âgés de > 40 ans et ≤ 85 ans
Les femmes en âge de procréer doivent obtenir un résultat négatif à un test de grossesse standard (urinaire ou sanguin)
Patients bénéficiant d’une chirurgie abdominale non urgente associée à une perte sanguine anticipée de ≥ 500 mL
Score ASA (état physique) de II – III
Formulaire de consentement éclairé signé |
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E.4 | Principal exclusion criteria |
Hypersensitivity to the active substances or to any of the other excipients of the investigational products
Body weight ≥ 140 kg
Sepsis
Burns
Renal impairment (AKIN stage ≥ 1 or chronic) or acute and/or chronic renal replacement therapy
Intracranial or cerebral haemorrhage
Critically ill patients (typically admitted to the intensive care unit)
Dehydration
Hyperhydration
Pulmonary oedema
Congestive heart failure
Severe hypernatraemia,
Severe hyperchloraemia
Hyperkalaemia
Metabolic alkalosis
Severely impaired hepatic function
Severe coagulopathy
Organ transplant patients
Simultaneous participation in another interventional trial (drugs or medical device) |
Hypersensibilité aux substances actives ou à l’un des excipients contenus dans les médicaments de l’étude
Masse corporelle ≥ 140 kg
Sepsis
Brûlures
Insuffisance rénale (stade AKIN ≥ 1 ou chronique), ou traitement de substitution rénale aigu et/ou chronique
Hémorragie intracrânienne ou cérébrale
Patients en état critique (habituellement admis en unité de soins intensifs)
Hyperhydratation
OEdème pulmonaire
Déshydratation
Hyperkaliémie
Hypernatrémie sévère
Hyperchlorémie sévère
Insuffisance hépatique sévère
Insuffisance cardiaque congestive
Coagulopathie sévère
Greffe d’organe
Alcalose métabolique
Participation simultanée à un autre essai clinique interventionnel (étude de médicaments ou de dispositifs médicaux) |
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E.5 End points |
E.5.1 | Primary end point(s) |
Difference in mean estimated glomerular filtration rate (eGFR) between the two treatment groups, calculated from the highest Cystatin-C level measured during post-operative days (POD) 1-3. |
Différence entre les deux groupes de traitement au niveau du débit de filtration glomérulaire estimé (DFGe) (calculé d’après les taux maximaux de cystatine C mesurés au cours des jours postopératoires (JPO) 1-3. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Cystatin-C levels will be determined on POD 1-3. eGFR will be calculated from the highest Cystain-C level during this period. |
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E.5.2 | Secondary end point(s) |
Safety
- Renal function: Cystatin-C, serum creatinine (SCr), Cystatin-C based estimated glomerular filtration rate (eGFR), Cystatin-C based mean eGFR, SCr based eGFR, AKIN & RIFLE score (calculated), unrine output (if available)
- Coagulation: Platelet count, International norm ration (INR), activated partial thromboplastin time (aPTT)
- Inflammation: C-reactive protein (C-RP)
- Adverse events: (serious) adverse events ((S)AEs / reactions ((S)ARs)
- Calculated red blood cell (RBC) loss
- Estimated intra-operative blood loss
- Outcome: Length of stay (LOS) in the hospital (LOS-H), LOS in the intensive care unit (LOS-ICU; if applicable), fit for discharge from ICU / hospital, hours on mechanical ventilation (MV), mortality (in hospital/out of hospital) and its cause, days on RRT, (new) renal replacement therapy (RRT)
Efficacy
- Fluid administration: administration of IP volume
- Fluid balance: fluid input and output
- Haemodynamics / vital signs: temperature (T), heart rate (HR), mean arterial pressure (MAP), systolic arterial blood pressure (SAP), diastolic arterial blood pressure (DAP), central venous pressure (CVP, if available)
- At least one of the following parameters to evaluate responsiveness and guide administration (vol guide): stroke volume (SV), stroke volume variation (SVV), stroke volume index (SVI), pulse pressure variation (PPV)
Arterial (preferred) Blood Gas Analysis (ABGA): partial pressure of carbondioxide (pCO2), partial pressure of oxygen (pO2), hydrogen carbonate (HCO3-), arterial oxygen saturation (SaO2), haemoglobin (Hb), haematocrit (Hct), pH, base excess (BE), lactate
centralvenous oxygen saturation (ScvO2)
Serum electrolytes (S elyte): Sodium, potassium, calcium, chloride
Major post-operative complications
Definition of time-points
Screening (within 1 week before surgery)
T0 (Baseline; after randomization and prior to induction of anaesthesia)
T1 (during surgery)
T2 (end of surgery)
T3 (POD 1 morning)
T4 (POD 2-3 morning)
T5 (POD 4-7 morning morning or hospital discharge, whatever occurs first)
T6 (POD 8-10 morning or hospital discharge, whatever occurs first)
T7 ( POD 28) ± 5 days
T8 (POD 90) ± 14 days
T9 (1 year PO) ± 30 days |
Sécurité
- Fonction rénale: Cystatine C, Dosage sérique de la créatinine (SCr), Débit de filtration glomérulaire estimé (DFGe) sur la base de la cystatine C, DFGe moyen sur la base de la cystatine C, DFGe calculé sur la base de la SCr, Score AKIN & RIFLE (calculé), Débit urinaire (si disponible)
- Coagulation: Numération plaquettaire, Ratio international normalisé (INR), Temps de céphaline activé (TCA)
- Inflammation Protéine C réactive (PCr)
- Événements indésirables: Événements / réactions indésirables (graves) (EI[G] / RI[G])
- Perte de globules rouges (GR) calculée
- Perte sanguine peropératoire estimée
- Issue: Durée de séjour (DDS) à l’hôpital (DDS-H), DDS en unité de soins intensifs (USI) (DDS-USI; le cas échéant), Déclaré apte à quitter l’USI/l’hôpital, Heures passées sous ventilation artificielle (VA), Mortalité (intra-hospitalière / extra-hospitalière) en précisant la cause, jours d’un TSR, (Nouveau) traitement de substitution rénale (TSR)
Efficacité
- Administration de liquide: Volume de produit de l’étude administré
- Équilibre hydrique: Apport et élimination hydrique
- Paramètres hémodynamiques / signes vitaux: Température (T), Fréquence cardiaque (FC), Pression artérielle moyenne (PAM), Pression artérielle systolique (PAS), Pression artérielle diastolique (PAD), Pression veineuse centrale (PVC) (si disponible)
- au moins l’un des paramètres suivants pour évaluer la réponse à l’expansion volémique et guider l’administration du produit de l’étude suivant l’algorithme volémique (vol guide) : Volume systolique (VS), Variation du volume systolique (VVS), Volume systolique indexé (VSI), Variation de la pression pulsée (VPP), Pression artérielle moyenne (PAM)
Analyse des gaz du sang (GDS) artériel (de préférence): Pression partielle du gaz carbonique (PCO2), Pression partielle de l’oxygène du sang (PO2), Bicarbonate (HCO3-), Saturation artérielle en oxygène (SaO2), Taux d’hémoglobine (Hb), Hématocrite (Ht), pH, Excès de bases, Lactate
Saturation veineuse centrale en oxygène (SvcO2)
Électrolytes sériques (ES): Sodium, Potassium, Calcium, Chlorure
Complications postopératoires majeures (CPM)
Sélection (dans un délai de 1 semaine avant la chirurgie)
T0 (Inclusion; après la randomisation et avant l’induction de l’anesthésie)
T1 (pendant la chirurgie)
T2 (fin de l’intervention chirurgicale)
T3 (1re matinée postopératoire)
T4 (2e & 3e matinées postopératoires)
T5 (de la 4e à la 7e matinée postopératoire, ou à la sortie d’hôpital, selon ce qui se produit en premier)
T6 (de la 8e à la 10e matinée postopératoire, ou à la sortie d’hôpital, selon ce qui se produit en premier
T7 (jour 28 après la chirurgie) ± 5 jours
T8 (jour 90 après la chirurgie) ± 14 jours
T9 (1 an après la chirurgie) ± 30 jours
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Cystatin-C: T0, T2-T8
SCr: T0, T2, T3, T4, T7, T8
Cystatin-C-based eGFR: T0, T2, T3, T4, T7, T8
Cystatin-C-based mean eGFR: T3-T6
SCr-based eGFR: T0, T2, T3, T4, T7, T8
AKIN and RIFLE: T0, T2, T3, T4, T7, T8
Urin output: T0, T2-T4
Coagulation: T0, T2, T3
C-RP: T0, T2, T3
(S)AEs/(S)ARs: T0-T8
Blood loss - RBC:T4 & intra-op: T2
LOS-H, LOS-ICU, Fit for discharge - H & ICU: daily
MV: T0-T5
Mortality (+ cause): T2-T5, T7, T8
RRT: T2-T5
new RRT after POD 7 or H- discharge: T7, T8
IP intake, fluid in-/output, fluid bal: T0-T4
T: T0, T2-T4
HR, MAP, SAP, DAP, CVP: T0, T1 (at least q 30 min), T2-T4
vol guide: during IP admin
ABGA: T0 + T2 (all); T3 + T4 (only Hb, Hct, lactate)
ScvO2: T0, T2, T3
S Elyte: T0, T2, T3
Maj compl: T3-T8 |
Cystatine C:T0,T2-T8
SCr:T0,T2,T3,T4,T7,T8
DFGe sur la base de la cystatine C:T0,T2,T3,T4,T7,T8
DFGe moyen sur la base de la cystatine C:T0,T2,T3,T4,T7,T8
DFGe sur la base de la SCr:T0,T2,T3,T4,T7,T8
AKIN & RIFLE:T0,T2,T3,T4,T7,T8
Débit urinaire:T0,T2-T4
Coagulation:T0,T2,T3
PCr:T0,T2,T3
EI[G]s/RI[G]s:T0-T8
Perte sanguine–GR:T4 & perop:T2
DDS-H, DDS-USI, Déclaré apte à quitter l’USI/l’H: par jour
VA:T0-T5
Mortalité (+cause):T2-T5,T7,T8
TSR:T2-T5
Nouveau TSR a JPO 7 ou à la sortie d’H:T7,T8
Administration de liquide, Apport/élimination hydrique, Équilibre hydrique:T0-T4
T:T0,T2-T4
FC, PAS, PAM, PAD, PVC:T0,T1(toutes les 30 min minimum),T2-T4
vol guide: a l’administration du produit
GDS:T0+T2(tous); T3+T4(Hb, Ht, Lactate)
SvcO2:T0,T2,T3
ES:T0,T2,T3
CPM:T3-T8
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 36 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Day 90 after surgery ± 14 days |
jour 90 après la chirurgie ± 14 jours |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 9 |
E.8.9.2 | In all countries concerned by the trial days | 0 |