A Net Ultrafiltration Challenge to Predict Preload-dependence (UF CHALLENGE) (UF CHALLENGE)
Acute Kidney Injury
About this trial
This is an interventional diagnostic trial for Acute Kidney Injury focused on measuring acute kidney injury, renal replacement therapy, hemodynamics, preload dependence, net ultrafiltration
Eligibility Criteria
Inclusion Criteria:
- adult patient, aged 18 year or older
- under mechanical ventilation and continuous general anesthesia, with a positive end-expiratory pressure of 5 cmH2O or more
- with stage 3 KDIGO acute kidney injury
- treated with continuous renal replacement therapy for less than 14 days
- ongoing continuous cardiac output monitoring
- with a predicted intensive care length of stay of 24 hours or more at time of screening
Exclusion Criteria:
- High arterial lactate concentration, > 4.0 mmol/L at time of screening
- Calibrated cardiac index < 2.0 L/min/m2 or > 4.0 L/min/m2 at time of screening
- Positive postural change maneuver in the last 2 hours preceding screening
- Patient under extracorporeal membrane oxygenation
- Patient with active bleeding requiring emergent transfusion
- Patient under chronic maintenance dialysis or renal transplant recipient
- Acute ischemic or hemorrhagic stroke complicated with coma and requiring mechanical ventilation
- Fulminant hepatitis (acute liver injury, hepatic encephalopathy, icterus and a drop in prothrombin < 50% in less that 15 days
- Impossible postural change maneuver
- Pregnant or lactating patient
- Imminent death
- Patient under legal protection measures as by French regulation
- Patient already enrolled in the present study
- Patient already participates in a study with protocolized net ultrafiltration, ongoing at time of screening
Sites / Locations
- Department of Intensive Care, Croix Rousse hospital, Hospices Civils de LyonRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Fast to Slow Group
Slow to Fast Group
The Fast to Slow Group corresponds to enrolled patients randomized, following the sequential crossover design, to first perform the fast UF challenge immediately after inclusion, followed by the slow UF challenge after a washout period of 24 hours.
The Slow to Fast Group corresponds to enrolled patients randomized, following the sequential crossover design, to first perform the slow UF challenge immediately after inclusion, followed by the fast UF challenge after a washout period of 24 hours.