search
Back to results

To Study the Effects of Lipid Emulsion on Hemodynamics in Organophosphate Compound Poisoning

Primary Purpose

Organophosphate Poisoning

Status
Completed
Phase
Phase 4
Locations
India
Study Type
Interventional
Intervention
Lipid Emulsion
Sponsored by
Postgraduate Institute of Medical Education and Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Organophosphate Poisoning

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria

  1. History of consumption of OP compound.
  2. Symptom complex consistent with OP poisoning
  3. Age > 18 years
  4. Informed consent from the patient or next kin.

Exclusion criteria

  1. History of combined poisoning with a non OP compound.
  2. All other patients not fitting in the organophosphate symptom complex.
  3. Patients with underlying liver and kidney disease.
  4. History suggestive of acute pancreatitis in the past.

Sites / Locations

  • Pgimer

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Study group

Historic controls

Arm Description

Inclusion criteria History of consumption of OP compound. Symptom complex consistent with OP poisoning Age > 18 years Informed consent from the patient or next kin. Exclusion criteria History of combined poisoning with a non OP compound. All other patients not fitting in the organophosphate symptom complex. Patients with underlying liver and kidney disease. History suggestive of acute pancreatitis in the past. All patients with history and clinical features of OP compound poisoning admitted to the emergency department in PGIMER during the study period, meeting the inclusion, exclusion criteria and who gave consent were enrolled in the study. Intervention : Administration of 100mL of 20% Lipid emulsion to all patients in the study group

The control arm The study group was compared with data of patients admitted for OP poisoning between the years 2013 and 2014 ( 2 calendar years), fulfilling the inclusion and exclusion criteria as stated above.

Outcomes

Primary Outcome Measures

Significant change in pulse from baseline to 72 hours after admission
The primary outcome was to study the change in 1.Pulse (beats/min) after delivery of lipid emulsion in OP poisoned individuals at various intervals of time from time of admission to 72 hours after administration of lipid emulsion and compare the same data with historic controls
Significant change in systolic blood pressure from baseline to 72 hours after admission
The primary outcome was to study the change in 2.Systolic blood pressure (mm Hg) after delivery of lipid emulsion in OP poisoned individuals at various intervals of time from time of admission to 72 hours after administration of lipid emulsion and compare the same data with historic controls
Significant change in oxygen arterial saturation from baseline to 72 hours after admission
Change in arterial oxygen saturation (SpO2) in percentage
Adverse effects
Incidence of adverse reactions in percentage
Significant change in diastolic blood pressure from baseline to 72 hours after admission
The primary outcome was to study the change in 5. Diastolic blood pressure (mm Hg) after delivery of lipid emulsion in OP poisoned individuals at various intervals of time from time of admission to 72 hours after administration of lipid emulsion and compare the same data with historic controls
Significant change in mean arterial pressure from baseline to 72 hours after admission
The primary outcome was to study the change in 6. Mean arterial pressure (mm Hg) after delivery of lipid emulsion in OP poisoned individuals at various intervals of time from time of admission to 72 hours after administration of lipid emulsion and compare the same data with historic controls

Secondary Outcome Measures

Effect on case fatality and morbidity
Secondary outcomes were to study the effects on 1. All cause mortality (in-hospital until discharge or death), that is the case fatality and morbidity in terms of duration of hospitalization in days, duration of mechanical ventilation in days, dose of atropine given in milligram an The data was compared with historic controls

Full Information

First Posted
May 3, 2016
Last Updated
June 10, 2018
Sponsor
Postgraduate Institute of Medical Education and Research
search

1. Study Identification

Unique Protocol Identification Number
NCT03564574
Brief Title
To Study the Effects of Lipid Emulsion on Hemodynamics in Organophosphate Compound Poisoning
Official Title
To Study the Effects of Lipid Emulsion on Hemodynamics in Organophosphate Compound Poisoning
Study Type
Interventional

2. Study Status

Record Verification Date
June 2018
Overall Recruitment Status
Completed
Study Start Date
September 2015 (Actual)
Primary Completion Date
December 2016 (Actual)
Study Completion Date
December 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Postgraduate Institute of Medical Education and Research

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
To Study the Effects of Lipid Emulsion on Hemodynamics in Organophosphate Compound Poisoning Objectives: To study the effect of administration of intravenous lipid emulsion on hemodynamic parameters, incidence of adverse effects in patients with organophosphate poisoning. Background: Lipid emulsion has been used to revert toxicities of lipophilic drugs, toxins (especially lignocaine) and in critically ill patients. Though the safety has been established, the effect on hemodynamics in Organophosphate (OP) poisoned patients has never been studied. Hence this study is underway to fill those lacunae and evaluate the safety profile of lipid emulsion in organophosphate poisoned patients. Methodology: The study is a prospective open label pilot study, which is underway at a tertiary care hospital in North India. Patients with history and clinical features of OP poisoning meeting the inclusion and exclusion parameters are being treated according to institutional protocols. Along with routine treatment a single dose of 20% lipid emulsion is being administered on admission to patients after obtaining consent. Patients are being followed up till discharge or death. Hemodynamic parameters and adverse effects following lipid emulsion administration are being studied over various intervals of time.
Detailed Description
Methods A prospective open label pilot study was conducted with an aim to study the safety and effects of 20% lipid emulsion in OP compound poisoning. The objectives were to study the effects on hemodynamic parameters, the effect on morbidity, mortality and the occurrence of adverse events. All patients, ≥ 13 years, with history of consumption of OP compound and clinical features of mild, moderate or severe OP compound poisoning as per the Peradeniya score (Table 1), admitted to the emergency department during the study period from September 2015 - December 2016 were included after written informed consent. Consent was obtained from the nearest kin if the presentation was with altered mental state. The recruitment began after approval from the institute's ethics committee. Patients with chronic liver or kidney disease, history of acute or chronic pancreatitis in the past, those with combined poisoning with non OP compounds and asymptomatic patients were not included. At presentation, detailed history was sought and subjects were examined for signs and symptoms of OP poisoning. Vital parameters (pulse rate, blood pressure, and respiratory rate) were noted. Blood samples were drawn for assessing baseline electrolytes, renal functions, haematological parameters and serum amylase. All patients received a single dose of 100mL of 20% lipid emulsion as an intra-venous infusion over 1 hour along with routine treatment as per institution protocols. Atropine was administered to patients by doubling dose method, which comprised of administering atropine starting from 2mg and to double the dose and administer till complete atropinization. Following this an infusion of 10-20 percent of the atropinizing dose was given every hour. In view of the controversial role of pralidoxime, it was not included in the study. The cases were followed up until recovery/death. The patients were under observation for their vital signs, pupil size, fasciculation, respiratory crackles, amount of oral secretions and, if intubated, tracheal secretion. In addition they underwent monitoring of vital parameters every ten minutes during the course of lipid administration for the first thirty minutes followed by every fifteen minutes during the next 2 hours and every 2nd hourly thereafter. Hemodynamic parameters, haematological, biochemical parameters, adverse effects and outcomes were compared at various intervals of time following administration of lipid emulsion, up to 72 hours, with those at the baseline; hemodynamic parameters were also compared with historic controls. The primary outcome was to study the change in hemodynamic parameters (pulse rate, systolic blood pressure, mean arterial pressure and respiratory rate) after delivery of lipid emulsion in OP poisoned individuals up to 72 hours and compare any changes in the hemodynamic parameters with that of historic controls. Secondary outcomes were to study the effects on case fatality (in-hospital until discharge or death), morbidity (duration of hospitalization, duration of mechanical ventilation, dose of atropine given) and the occurrence of complications including those related to lipid emulsion and hospital acquired infections.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Organophosphate Poisoning

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Study group
Arm Type
Experimental
Arm Description
Inclusion criteria History of consumption of OP compound. Symptom complex consistent with OP poisoning Age > 18 years Informed consent from the patient or next kin. Exclusion criteria History of combined poisoning with a non OP compound. All other patients not fitting in the organophosphate symptom complex. Patients with underlying liver and kidney disease. History suggestive of acute pancreatitis in the past. All patients with history and clinical features of OP compound poisoning admitted to the emergency department in PGIMER during the study period, meeting the inclusion, exclusion criteria and who gave consent were enrolled in the study. Intervention : Administration of 100mL of 20% Lipid emulsion to all patients in the study group
Arm Title
Historic controls
Arm Type
No Intervention
Arm Description
The control arm The study group was compared with data of patients admitted for OP poisoning between the years 2013 and 2014 ( 2 calendar years), fulfilling the inclusion and exclusion criteria as stated above.
Intervention Type
Combination Product
Intervention Name(s)
Lipid Emulsion
Other Intervention Name(s)
Intralipid 20 percent
Intervention Description
All patients in the 'Study group' received a single dose of 100 ml of 20 percent Lipid emulsion as an infusion over 1 hour along with routine treatment as per institution protocols. Atropine was administered to patients by doubling dose method, which comprised of administering atropine starting from 2mg and to double the dose and administer till complete atropinization. Following this an infusion of 10 percent of the atropinizing dose was given every hour. Patients were evaluated using a standardized clinical interview, physical examination, laboratory tests.
Primary Outcome Measure Information:
Title
Significant change in pulse from baseline to 72 hours after admission
Description
The primary outcome was to study the change in 1.Pulse (beats/min) after delivery of lipid emulsion in OP poisoned individuals at various intervals of time from time of admission to 72 hours after administration of lipid emulsion and compare the same data with historic controls
Time Frame
Date of admission up to 72 hours
Title
Significant change in systolic blood pressure from baseline to 72 hours after admission
Description
The primary outcome was to study the change in 2.Systolic blood pressure (mm Hg) after delivery of lipid emulsion in OP poisoned individuals at various intervals of time from time of admission to 72 hours after administration of lipid emulsion and compare the same data with historic controls
Time Frame
Date of admission up to 72 hours
Title
Significant change in oxygen arterial saturation from baseline to 72 hours after admission
Description
Change in arterial oxygen saturation (SpO2) in percentage
Time Frame
Date of admission up to 72 hours
Title
Adverse effects
Description
Incidence of adverse reactions in percentage
Time Frame
Date of admission until discharge/death of subjects up to 1 month
Title
Significant change in diastolic blood pressure from baseline to 72 hours after admission
Description
The primary outcome was to study the change in 5. Diastolic blood pressure (mm Hg) after delivery of lipid emulsion in OP poisoned individuals at various intervals of time from time of admission to 72 hours after administration of lipid emulsion and compare the same data with historic controls
Time Frame
Date of admission up to 72 hours
Title
Significant change in mean arterial pressure from baseline to 72 hours after admission
Description
The primary outcome was to study the change in 6. Mean arterial pressure (mm Hg) after delivery of lipid emulsion in OP poisoned individuals at various intervals of time from time of admission to 72 hours after administration of lipid emulsion and compare the same data with historic controls
Time Frame
Date of admission up to 72 hours
Secondary Outcome Measure Information:
Title
Effect on case fatality and morbidity
Description
Secondary outcomes were to study the effects on 1. All cause mortality (in-hospital until discharge or death), that is the case fatality and morbidity in terms of duration of hospitalization in days, duration of mechanical ventilation in days, dose of atropine given in milligram an The data was compared with historic controls
Time Frame
Admission to the hospital till time of discharge up to 1 month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria History of consumption of OP compound. Symptom complex consistent with OP poisoning Age > 18 years Informed consent from the patient or next kin. Exclusion criteria History of combined poisoning with a non OP compound. All other patients not fitting in the organophosphate symptom complex. Patients with underlying liver and kidney disease. History suggestive of acute pancreatitis in the past.
Facility Information:
Facility Name
Pgimer
City
Chandigarh
ZIP/Postal Code
160012
Country
India

12. IPD Sharing Statement

Plan to Share IPD
Yes
Citations:
PubMed Identifier
30307350
Citation
Chhabria BA, Bhalla A, Shafiq N, Kumar S, Dhibar DP, Sharma N. Lipid emulsion for acute organophosphate insecticide poisoning - a pilot observational safety study. Clin Toxicol (Phila). 2019 May;57(5):318-324. doi: 10.1080/15563650.2018.1520997. Epub 2018 Oct 11.
Results Reference
derived

Learn more about this trial

To Study the Effects of Lipid Emulsion on Hemodynamics in Organophosphate Compound Poisoning

We'll reach out to this number within 24 hrs