Conservative vs liberal fluid therapy in septic shock (CLASSIC) trial-Protocol and statistical analysis plan

INTRODUCTION

Intravenous (IV) fluid is a key intervention in the management of septic shock. The benefits and harms of lower versus higher fluid volumes are unknown and thus clinical equipoise exists. We describe the protocol and detailed statistical analysis plan for the conservative versus liberal approach to fluid therapy of septic shock in the Intensive Care (CLASSIC) trial. The aim of the CLASSIC trial is to assess benefits and harms of IV fluid restriction versus standard care in adult intensive care unit (ICU) patients with septic shock.

METHODS

CLASSIC trial is an investigator-initiated, international, randomised, stratified, and analyst-blinded trial. We will allocate 1554 adult patients with septic shock, who are planned to be or are admitted to an ICU, to IV fluid restriction versus standard care. The primary outcome is mortality at day 90. Secondary outcomes are serious adverse events (SAEs), serious adverse reactions (SARs), days alive at day 90 without life support, days alive and out of the hospital at day 90 and mortality, health-related quality of life (HRQoL), and cognitive function at 1 year. We will conduct the statistical analyses according to a pre-defined statistical analysis plan, including three interim analyses. For the primary analysis, we will use logistic regression adjusted for the stratification variables comparing the two interventions in the intention-to-treat (ITT) population.

DISCUSSION

The CLASSIC trial results will provide important evidence to guide clinicians' choice regarding the IV fluid therapy in adults with septic shock.

[Detection of atypical toxin-producing Pasteurella strains on the nasal mucosa of calves and their differential diagnostic limits for Pasteurella haemolytica and Pasteurella multocida]

The bacterial colonisation on nasal mucous membranes of calves at age of 3, 5 to 5 months was investigated by cotton swabs. Three Pasteurella species were found (P. multocida subspecies multocida, P. haemolytica, P. avium) as monocausal infection as well as pluricausal infection. P. avium was characterised by colonial morphology, bacterioscopy, biochemical properties, polypeptide-pattern in SDS-PAGE and by electronmicroscopic investigation and was differentiated from P. multocida and P. haemolytica. It is very interesting, that the P. avium strains possess an antigen structure, reacting with monoclonal antibodies directed against the heat labile-toxin of P. multocida subspecies multocida.