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Trial registered on ANZCTR
Registration number
ACTRN12624000991516p
Ethics application status
Submitted, not yet approved
Date submitted
30/07/2024
Date registered
13/08/2024
Date last updated
13/08/2024
Date data sharing statement initially provided
13/08/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
SLeep Evaluation and Effectiveness Protocol for Intensive Care Units (SLEEP-ICU)
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Scientific title
A randomised, placebo controlled clinical trial of the efficacy of dexmedetomidine as part of a sleep promotion bundle on sleep quality in adults in intensive care who report a subjective sleep disturbance
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Secondary ID [1]
312651
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nil known
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Universal Trial Number (UTN)
U1111-1309-6642
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Trial acronym
SLEEP-ICU
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Sleep deprivation
334616
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Delirium
334617
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Condition category
Condition code
Neurological
331202
331202
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0
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Other neurological disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Dexmedetomidine
Description: A once only intravenous administration of dexmedetomidine as part of a sleep promotion bundle.
Dose: Variable titration per patient based on clinical response, starting at 0.2 and up to 0.7 mcg/kg/hour.
Duration of administration: 9 hours from 21:00 to 06:00 the next morning
Mode of administration: Continuous intravenous infusion.
Sleep Promotion Bundle
Description: A 'Sleep Promotion Bundle Checklist' will be provided to the bedside nurse to address to all the items in the sleep promotion bundle which include:
1. Environmental Modifications/Monitoring
Setup of sleep environment monitor by bedside to assess environmental conditions including ambient light (measured in lux), temperature (in degrees Celsius) and noise (in decibels) which will be recorded minutely throughout the 9-hour intervention period (2100-0600hrs).
Lighting Adjustments (<10lux)
adjusting lights in the patient’s room and surroundings to aim for <10 lux according to ambient light instrument during 9-hour intervention period (2100-0600hrs)
offering an eye mask for the patient if appropriate
Noise Reduction (<40dB)
Aim to keep noise below 40db according to decibel reader instrument
Minimising equipment volume and alarms
Encouraging staff to speak softly and close doors quietly
Offering earplugs for the patient
Temperature Control (20-22 C)
Ensuring room temperature is at recommended temperature range according to temperature monitoring device (20-22 degrees Celsius)
Providing fans or cooling blankets if the patient is too warm
Offering warming blankets to maintain the appropriate temperature
Comfort and Positioning
The goal is to ensure patient comfort. Nurses will adjust pillows and bedding to achieve the most comfortable position for the patient as subjectively reported by patient. There is no specific guideline for proper positioning, and this may vary based on individual needs and clinical judgment or requirement.
2. Scheduling and Routine
Nighttime Routine
Offering warm drinks (if allowed) and assisted with hygiene needs before sleep
Limiting non-essential care and procedures during nighttime hours
Cluster Care Activities
Clustering necessary care activities to minimise disturbances
Scheduling medications, vital sign checks, and other care tasks to allow uninterrupted sleep periods
3. Medications and Interventions
Review Medications
Reviewing the appropriateness of any overnight medications that may disrupt sleep
Pain Management
Assessing and managing the patient’s pain effectively
4. Patient-Centered Care
Sleep Assessments
Conducting baseline sleep assessment to understand the patient’s specific needs and preferences using provided sleep questionnaire
Patient Education
Nurses and research staff will provide education to the patient and their family about the importance of sleep and ways to promote it through the patient information and consent form discussion. The content and duration of this education can be customised based on the patient’s condition and preferences.
5. Additional Considerations
Cultural and Individual Preferences
The bundle acknowledges and respects the patient’s cultural and personal preferences. Staff will incorporate these preferences into sleep hygiene practices. For example, considering cultural norms related to bedtime routines or personal preferences for sleep environment. This will be asked as a question from bedside nurse or research staff and acted on as deemed appropriate by bedside nurse.
Family Involvement
Family members may be actively involved in establishing a calming bedtime routine if available. This may include providing emotional support, assisting with comfort measures, and promoting a soothing environment. This can be organised and as deemed appropriate by bedside nurse.
Strategies used to manage adherence to the interventions:
Monitoring electronic medical records, nursing checklist, staff training and direct supervision from senior nursing.
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Intervention code [1]
329170
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Treatment: Drugs
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Intervention code [2]
329171
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Prevention
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Comparator / control treatment
Placebo: Intravenous infusion of 0.9% normal saline for 9 hours at 5ml/hr
Those receiving this placebo treatment will also receive the same aspects of the sleep promotion bundle as dexmedetomidine group.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Change in sleep quality
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Assessment method [1]
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Measured using the Richards-Campbell Sleep Questionnaire (RCSQ) completed by participants. Specifically, the ‘Sleep Quality’ domain will determine overall sleep quality, however this will also be determined through the other metrics of the subjective sleep assessment tool, such as sleep latency, depth, awakenings and ability to return to sleep.
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Timepoint [1]
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Prior to 2100hrs (when intervention due to start) and after 0600hrs (after intervention has finished)
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Secondary outcome [1]
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ICU length of stay
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Assessment method [1]
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ICU electronic medical records data
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Timepoint [1]
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From time and date of ICU admission to time and date of ICU discharge
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Secondary outcome [2]
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ICU mortality
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Assessment method [2]
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Hospital and ICU electronic medical records data
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Timepoint [2]
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From date and time of randomisation to date and time of death in ICU
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Secondary outcome [3]
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Pharmacological interventions for delirium received during ICU admission.
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Assessment method [3]
438132
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ICU electronic medical records
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Timepoint [3]
438132
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From enrollment to ICU discharge
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Secondary outcome [4]
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Incidence of Delirium at Day 1
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Assessment method [4]
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Assessed using the standardised delirium assessment tool Confusion Assessment Method for the ICU (CAM-ICU)
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Timepoint [4]
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two assessments, one at enrollment (baseline) and one post intervention up until the end of day 1 of receiving study intervention (eg. intervention runs 2100 to 0600hrs, CAM-ICU would need to be completed after 0600 and by midnight of that day).
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Secondary outcome [5]
438134
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Study drug infusion cessation due to possible adverse events including hypotension and bradycardia
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Assessment method [5]
438134
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ICU electronic medical records data
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Timepoint [5]
438134
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During study intervention period
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Secondary outcome [6]
438135
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Number of hours study drug received during intervention period (2100-0600)
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Assessment method [6]
438135
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ICU electronic medical records data
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Timepoint [6]
438135
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during study intervention period
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Secondary outcome [7]
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Hospital length of stay
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Assessment method [7]
438286
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Hospital medical records
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Timepoint [7]
438286
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From time and date of hospital admission to time and date of hospital discharge
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Secondary outcome [8]
438287
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Hospital mortality
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Assessment method [8]
438287
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Hospital medical records
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Timepoint [8]
438287
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From date and time of randomisation to date and time of death in hospital
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Eligibility
Key inclusion criteria
1. Adult patient aged 18 years or older admitted to the ICU
2. Expected to remain in the ICU overnight from the time of enrollment.
3. Capacity to complete a self-reported sleep assessment*
4. Subjectively reported sleep disturbance during the current ICU admission**
* Absence of altered mental state and ability to understand sleep questions and provide responses
** According to patient-reported survey (Richards-Campbell Sleep Questionnaire)
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Contraindication to dexmedetomidine (including but not limited to allergy and bradycardia)
2. Currently receiving dexmedetomidine
3. Treating clinician believes study participation is not in the patient’s best interest
4. Pregnancy or breastfeeding
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
central randomisation by computer
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Permuted block randomisation
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/10/2024
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Actual
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Date of last participant enrolment
Anticipated
1/10/2025
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Actual
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Date of last data collection
Anticipated
1/11/2025
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Actual
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Sample size
Target
72
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
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Fiona Stanley Hospital - Murdoch
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Recruitment postcode(s) [1]
42948
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6150 - Murdoch
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Funding & Sponsors
Funding source category [1]
317082
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Hospital
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Name [1]
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Fiona Stanley Hospital
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Address [1]
317082
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Country [1]
317082
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Australia
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Primary sponsor type
Government body
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Name
South Metropolitan Health Service
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Address
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Country
Australia
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Secondary sponsor category [1]
319339
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Hospital
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Name [1]
319339
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Fiona Stanley Hospital
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Address [1]
319339
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Country [1]
319339
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Australia
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
315834
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South Metropolitan Health Service Human Research Ethics Committee
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Ethics committee address [1]
315834
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https://smhs.health.wa.gov.au/Our-research/For-researchers
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Ethics committee country [1]
315834
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Australia
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Date submitted for ethics approval [1]
315834
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31/07/2024
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Approval date [1]
315834
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Ethics approval number [1]
315834
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Summary
Brief summary
Incorporating dexmedetomidine into a comprehensive sleep promotion bundle, which includes minimising night-time disruptions and aligning care activities with the patient’s natural sleep-wake cycles, optimising the sleep environment through monitoring temperature, noise and ambient light could significantly enhance sleep quality in ICU patients. Improved sleep may contribute to better recovery outcomes, reduction in delirium incidence, and overall improved patient well-being. The primary objective of this trial is to provide a comprehensive evaluation of the efficacy and safety of dexmedetomidine in improving sleep in adult ICU patients as part of a sleep promotion bundle as determined by the patient’s subjective sleep assessment.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Mr Nicholas Anthony
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Address
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Intensive Care Unit, Fiona Stanley Hospital 11 Robin Warren Drive, Murdoch Western Australia 6150
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Country
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Australia
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Phone
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+61 861526545
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Nicholas Anthony
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Address
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Intensive Care Unit, Fiona Stanley Hospital 11 Robin Warren Drive, Murdoch Western Australia 6150
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Country
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Australia
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Phone
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+61 861526545
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Fax
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Email
135947
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[email protected]
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Contact person for scientific queries
Name
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Nicholas Anthony
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Address
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Intensive Care Unit, Fiona Stanley Hospital 11 Robin Warren Drive, Murdoch Western Australia 6150
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Country
135948
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Australia
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Phone
135948
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+61 861526545
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Fax
135948
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Email
135948
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
undecided
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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