Non-invasive Goal-directed thErapy oN cIrcUlatory Shock (GENIUS)
Acute Kidney Injury Due to Circulatory Failure
About this trial
This is an interventional treatment trial for Acute Kidney Injury Due to Circulatory Failure focused on measuring Acute Kidney Injury, Shock, Early Goal Directed Therapy
Eligibility Criteria
Inclusion Criteria:
- Age > 18 years;
- Patients with shock defined as:
Systolic Blood Pressure (SBP) < 90 mmHg and/or Mean Arterial Pressure (MAP) < 70 mmHg and
At least one of the following alterations:
- Lactate > 18 mg/dL;
- Oliguria (diuresis < 0.5 mL/Kg/min for at least 6 hours);
- Neurological alteration (mental confusion, lowered level of consciousness, psychomotor agitation, temporal-spatial disorientation);
- Capillary refill time > 3 s (after 10 seconds of fingertip compression).
Exclusion Criteria:
- Significant edema in the fingers;
- Significant peripheral vasoconstriction;
- Use of Noradrenaline at a dose greater than or equal to 0.2 mcg/Kg/min;
- Presence of Aortic Insufficiency;
- Patients on Renal Replacement Therapy;
- Patients with acute ST-elevation Myocardial Infarction;
- Patients in need of Invasive Mechanical Ventilation;
- Patients already participating in another study.
Sites / Locations
- Instituto do CoraçãoRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Goal-Directed Therapy Group
Conventional Therapy Group
Patients allocated to the Goal-Directed Therapy group will be monitored by the ClearSight™ System (Edwards Life Sciences, Irvine, CA, USA) in the first 24 hours after randomization, where the parameters Cardiac Index (CI), Stroke Volume (SV), Systolic Blood Pressure (SBP) and Mean Arterial Pressure (MAP) will be acquired continuously.
Patients allocated to the Conventional Therapy Group will be treated according to the assistant team of the Emergency Unit, where will be measured the following parameters: invasive or non-invasive blood pressure (decided by the assistant team), peripheral oximetry, heart and respiratory rate, urinary output, in association with clinical history, complete physical examination and laboratory and imaging tests.