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The Influence of Furosemide on Fluid Balance and Intra-abdominal Pressure in Critically Ill Patients

Primary Purpose

Intra-Abdominal Hypertension

Status
Unknown status
Phase
Not Applicable
Locations
Belgium
Study Type
Interventional
Intervention
furosemide
Sponsored by
Ziekenhuis Netwerk Antwerpen (ZNA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Intra-Abdominal Hypertension focused on measuring abdominal compartment syndrome, intra-abdominal pressure, furosemide, fluid balance

Eligibility Criteria

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

Inclusion Criteria:

  • Adult (>18y)
  • Sedation (Richmond Agitation and Sedation Score RASS ≤ -3) and mechanical ventilation anticipated to last for at least an additional 72h
  • Indication for IAP monitoring according to the recommendations published by the WSACS
  • IAP ≥ 12mmHg (intravesical IAP measurement according to WSACS guidelines)
  • Absence of surgically treatable abdominal lesions
  • Presence of fluid overload

Exclusion Criteria:

  • Pregnancy or lactation
  • Assisted spontaneous breathing ventilator mode
  • Chronic diuretic therapy or on diuretics during inclusion
  • Contra-indication to bladder catheterization such as bladder surgery or genitourinary trauma
  • Known hypersensitivity to furosemide
  • Renal failure Acute Kidney Injury Network (AKIN) class 3
  • Patients requiring high dose vasopressors (norepinephrine >0.5µg/kg/min, dobutamine >10µg/kg/min or dopamine>10µg/kg/min, epinephrine>0.5µg/kg/min)
  • Intra-abdominal pressure (IAP) >25mmHg at study entry
  • DNR orders in effect (other than DNR 1 'no CPR' order)
  • Patient not expected to survive for 7 days
  • Advanced liver cirrhosis (see pharmaceutical information on furosemide)
  • paO2/FiO2 ratio of <100
  • oliguria <500mL/24h preceding inclusion

Sites / Locations

  • ZNA Stuivenberg Intensive Care UnitRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Control group

Furosemide group

Arm Description

Patients will be receiving standard of care ICU treatment of their underlying disease according to internationally accepted guidelines and recommendations.

patients will be receiving standard of care ICU treatment of their underlying condition according to international guidelines and recommendations. In addition, furosemide will be administered in continuous infusion as per protocol in order to achieve a preset target diuresis that is adjusted according to haemodynamic tolerance.

Outcomes

Primary Outcome Measures

intra-abdominal pressure

Secondary Outcome Measures

serum creatinine
need for renal replacement therapy
ICU mortality
acid-base status
hospital and 28d mortality
duration of mechanical ventilation
ICU length of stay
vasopressor dose
fluid balance
SOFA score

Full Information

First Posted
February 18, 2010
Last Updated
February 19, 2010
Sponsor
Ziekenhuis Netwerk Antwerpen (ZNA)
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1. Study Identification

Unique Protocol Identification Number
NCT01072071
Brief Title
The Influence of Furosemide on Fluid Balance and Intra-abdominal Pressure in Critically Ill Patients
Official Title
The Influence of Furosemide on Fluid Balance and Intra-abdominal Pressure in Mechanically Ventilated Critically Ill Patients With Secondary Intra-abdominal Hypertension
Study Type
Interventional

2. Study Status

Record Verification Date
February 2010
Overall Recruitment Status
Unknown status
Study Start Date
February 2010 (undefined)
Primary Completion Date
December 2011 (Anticipated)
Study Completion Date
March 2012 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Ziekenhuis Netwerk Antwerpen (ZNA)

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Intra-abdominal hypertension (IAH) is a frequent cause of organ dysfunction in critically ill patients. Secondary IAH is mainly caused by excessive fluid resuscitation.The World Society for the Abdominal Compartment Syndrome (WSACS) recommends using diuretics to remove excess fluids and decrease intra-abdominal pressure (IAP). However, critically ill patients may not tolerate negative fluid balance in the acute phase of their disease and the injured kidney may not respond to diuretics. The aim of this study is to evaluate the influence of furosemide on fluid balance, IAP and kidney function in critically ill patients.
Detailed Description
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been shown to cause organ dysfunction and mortality in different populations of critically ill patients. According to consensus definitions published by the World Society for the Abdominal Compartment Syndrome (WSACS), secondary IAH is due to a disease process outside the abdominal cavity. It is mainly caused by massive fluid resuscitation leading to bowel and abdominal wall edema or increased intra-abdominal volume and decreased abdominal wall compliance. Large observational studies have shown that positive fluid balance is an independent risk factor for mortality. The development of secondary IAH may be one of the mechanisms involved in this phenomenon. This has lead to the hypothesis that prognosis may be improved by managing fluid overload and aiming for a negative fluid balance as soon as possible after the resuscitation phase of the disease. Several authors have shown in case reports and small series that renal replacement therapy with ultrafiltration can be used successfully to remove excess fluid and lower intra-abdominal pressure (IAP), but renal replacement therapy is invasive and clinicians may be reluctant in considering this therapy in patients with preserved diuresis and kidney function. In an effort to achieve the same goal using a less invasive technique, the new medical management algorithm for IAH published by the WSACS recommends the use of judicious diuresis in order to achieve a negative fluid balance and a decrease in IAP. However, the kidney is especially sensitive to the deleterious effects of IAH and may be unresponsive to diuretics in the presence of IAH. Also, ongoing inflammation and capillary leak may lead to relative hypovolemia and impaired response to diuretics. We plan a multicenter study to evaluate the influence of furosemide on fluid balance and IAP in critically ill patients with secondary intra-abdominal hypertension and to document the effect on the function of other organ systems. The aim of this study is to evaluate the feasibility and the safety of the furosemide administration protocol and to provide preliminary data to allow for an adequate power calculation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Intra-Abdominal Hypertension
Keywords
abdominal compartment syndrome, intra-abdominal pressure, furosemide, fluid balance

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Control group
Arm Type
No Intervention
Arm Description
Patients will be receiving standard of care ICU treatment of their underlying disease according to internationally accepted guidelines and recommendations.
Arm Title
Furosemide group
Arm Type
Experimental
Arm Description
patients will be receiving standard of care ICU treatment of their underlying condition according to international guidelines and recommendations. In addition, furosemide will be administered in continuous infusion as per protocol in order to achieve a preset target diuresis that is adjusted according to haemodynamic tolerance.
Intervention Type
Drug
Intervention Name(s)
furosemide
Other Intervention Name(s)
Lasix (Sanofi-Aventis)
Intervention Description
Loading dose: 0,5mg/kg Start continuous infusion at a dose of 0,1mg/kg/h and titrate according to diuretic response. Target value for diuresis = (amount of fluids administered at inclusion/kg/h) + 0.5mL/kg/h If safety check is satisfactory: increase target diuresis with 1mL/kg/h per 4h to a maximum of (amount of fluids administered at inclusion/kg/h) + 2.5mL/kg/h Maximal dose of furosemide: 0.3mg/kg/h Safety check every 4h. Furosemide is administered for 24h. If safety checks are satisfactory, additional periods of 24 can be added up to a maximum of 72h.
Primary Outcome Measure Information:
Title
intra-abdominal pressure
Time Frame
every 4 hours during furosemide administration and daily for 7 days
Secondary Outcome Measure Information:
Title
serum creatinine
Time Frame
daily for 7 days
Title
need for renal replacement therapy
Time Frame
daily for 7 days
Title
ICU mortality
Time Frame
3 months
Title
acid-base status
Time Frame
daily for 7 days
Title
hospital and 28d mortality
Time Frame
after 28 days and after 6 months
Title
duration of mechanical ventilation
Time Frame
3 months
Title
ICU length of stay
Time Frame
3 months
Title
vasopressor dose
Time Frame
daily for 7 days
Title
fluid balance
Time Frame
daily for 7 days
Title
SOFA score
Time Frame
daily for 7 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult (>18y) Sedation (Richmond Agitation and Sedation Score RASS ≤ -3) and mechanical ventilation anticipated to last for at least an additional 72h Indication for IAP monitoring according to the recommendations published by the WSACS IAP ≥ 12mmHg (intravesical IAP measurement according to WSACS guidelines) Absence of surgically treatable abdominal lesions Presence of fluid overload Exclusion Criteria: Pregnancy or lactation Assisted spontaneous breathing ventilator mode Chronic diuretic therapy or on diuretics during inclusion Contra-indication to bladder catheterization such as bladder surgery or genitourinary trauma Known hypersensitivity to furosemide Renal failure Acute Kidney Injury Network (AKIN) class 3 Patients requiring high dose vasopressors (norepinephrine >0.5µg/kg/min, dobutamine >10µg/kg/min or dopamine>10µg/kg/min, epinephrine>0.5µg/kg/min) Intra-abdominal pressure (IAP) >25mmHg at study entry DNR orders in effect (other than DNR 1 'no CPR' order) Patient not expected to survive for 7 days Advanced liver cirrhosis (see pharmaceutical information on furosemide) paO2/FiO2 ratio of <100 oliguria <500mL/24h preceding inclusion
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Inneke E De laet, MD
Phone
+32476216120
Email
inneke.delaet@zna.be
First Name & Middle Initial & Last Name or Official Title & Degree
Manu Malbrain, MD PhD
Phone
+3232177399
Email
manu.malbrain@zna.be
Facility Information:
Facility Name
ZNA Stuivenberg Intensive Care Unit
City
Antwerpen
ZIP/Postal Code
2060
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Inneke E De laet, MD
Phone
+32476216120
Email
inneke.delaet@zna.be
First Name & Middle Initial & Last Name & Degree
Manu Malbrain, MD PhD
Phone
+3232177399
Email
manu.malbrain@zna.be

12. IPD Sharing Statement

Links:
URL
http://www.wsacs.org
Description
World Society for the Abdominal Compartment Syndrome Official Website

Learn more about this trial

The Influence of Furosemide on Fluid Balance and Intra-abdominal Pressure in Critically Ill Patients

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