E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Bacterial Endocarditis |
Bakteriel endokardit |
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E.1.1.1 | Medical condition in easily understood language |
Treatment of bacterial infection of the inner lining of the heart and valves using hyperbaric oxygen therapy. |
Behandling af bakteriel infektion af hjertets indre overflade og klapper ved brug af hyperbar oxygen behandling. |
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E.1.1.2 | Therapeutic area | Analytical, Diagnostic and Therapeutic Techniques and Equipment [E] - Therapeutic techniques [E02] |
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 | 10057480 |
E.1.2 | Term | Hyperbaric oxygen therapy |
E.1.2 | System Organ Class | 10042613 - Surgical and medical procedures |
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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 |
To assess feasibility including patient compliance of adding HyperBaric Oxygen Treatment (HBOT) to the standard management of patients with proven bacterial endocarditis. |
At vurdere gennemførligheden for adjuverende hyperbar iltbehandling til patienter med bakteriel endokardit. |
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E.2.2 | Secondary objectives of the trial |
Not applicable |
Ikke relevant |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1) Left sided IE with gram positive cocci. 2) IE has been diagnosed according to modified Duke Criteria. 3) Patients must be stable, by means of no need for hemodynamic pressure support. 4) The patient must be able to be seated for the 1.5 hour the HBOT at least two times a day for 3 days. 5) The patient must be able to perform Valsalva’s – or Frenzels manoeuvre – to equalize middle ear pressure. As prophylaxis, all patients will receive detumescent nose drops as Otrivin® to facilitate ear- and sinuses equilibration. In the rare event it is still not possible for the patient to equalize pressure, a paracentesis or drainage of the tympanic membrane must be performed by the ENT doctor. All according to daily practice. 6) The upstart of HBOT must be within the first week of relevant antibiotic IE therapy. 7) If a central venous catheter has been inserted, a chest X-ray must confirm no suspicion of pneumothorax. 8) Patients must be >18-years old.
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1) Venstre sidet IE med gram positive cocci. 2) IE er blevet diagnosticeret i henhold til Duke Criteria. 3) Patienterne skal være stabile, uden behov for hæmodynamisk inotropi støtte. 4) Patienten skal kunne sidde i 1,5 time HBOT mindst to gange om dagen i 3 dage. 5) Patienten skal kunne udføre Valsalvas - eller Frenzels manøvre - for at udligne trykket i mellemøret. Som profylakse vil alle patienter modtage detumecerende næsedråber som Otrivin® for at lette øre- og bihule trykudligning. I sjældne tilfælde hvor det ikke er muligt for patienten at udligne trykket, udføres en paracentese eller dræning af tympanisk membrana tymp. ved ØNH-læge. 6) Opstart af HBOT skal være inden for den første uge af relevant antibiotisk IE-terapi. 7) Hvis et centralt venøst kateter er blevet indsat, skal røntgen af thorax udelukke pneumothorax. 8) Patienterne skal være> 18 år gamle. |
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E.4 | Principal exclusion criteria |
1) Claustrophobia that cannot be reversed by mild sedatives. 2) Patients requiring mechanical ventilation. 3) Undrained pneumothorax 4) Pregnancy 5) Unable to follow and understand simple commands 6) Non-compliant
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1) Claustrofobi, der ikke kan reverseres af milde sedativer. 2) Patienter, der kræver mekanisk ventilation. 3) Udræneret pneumothorax 4) Graviditet 5) Hvis ikke kan følge og forstå enkle kommandoer og instrukser 6) Manglende kompliance |
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E.5 End points |
E.5.1 | Primary end point(s) |
Observations of interest / endpoints: 1) Patient baseline data 2) Patient compliance (tolerance/acceptance of the treatment – and number of the scheduled 6 treatments accepted by the patients) 3) Practical feasibility (are we capable of organising all 6 treatments for the individual patients according to the protocol) 4) Findings at echocardiography (TTE/TEE) within 48 h before HBOT and < 48 h after last HBOT 5) Daily blood samples with infection parameters: CRP, PCT, leukocyte + differential count, Hb 6) One blood sample for Biomarkers (10mL EDTA) 7) Blood cultures of patients daily 8) Blood sample for Dihydrorhodamin testing (DHR, functionality of the PMNs respiratory burst capacity) and fagocytosis test less than one hour before the first daily HBOT and right after. Likewise, for the coagulation status by means of TEG/rotem analysis.
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Observationer af interesse / slutpunkter: 1) Patientbaseline data 2) Patient kompliance (tolerance / accept af behandlingen - og antal af de planlagte 6 behandlinger accepteret af patienterne) 3) Praktisk gennemførlighed (kan vi organisere alle 6 behandlinger for de enkelte patienter i henhold til protokollen) 4) Resultater ved ekkokardiografi (TTE / TEE) inden for 48 timer før HBOT og <48 timer efter sidste HBOT 5) Daglige blodprøver med infektionsparametre: CRP, PCT, leukocyt + differentialtælling, Hb 6) En blodprøve til biomarkører (10 ml EDTA) 7) Blodkulturer af patienter dagligt 8) Blodprøve til Dihydrorhodamin-testning (DHR, funktionalitet af PMNs respiratorisk udbrydningskapacitet) og fagocytose test mindre end en time før den første daglige HBOT og lige efter. På samme måde for koagulationsstatus ved hjælp af TEG / rotem analyse. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Patient endpoints at minimum 48 hours after last HBOT session during hospitalization and until discharge. |
Patient udkomme ved minimum 48 timer efter sidste HBOT session under hospitalisering og indtil udskrivning. |
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E.5.2 | Secondary end point(s) |
Not applicable. |
Ikke relevant. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Not applicable. |
Ikke relevant. |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | No |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
This is a feasibility study. |
Dette er et gennemførligheds- og patient kompliance studie. |
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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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
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) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
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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Last patient last visit (LVLS). |
Sidste patients sidste besøg (LVLS). |
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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 | |
E.8.9.1 | In the Member State concerned days | |