None listed
Conditions
Brief summary
Many patients admitted to the Intensive Care Unit (ICU) with a critical illness suffer from acute kidney injury. Acute kidney injury often requires the use of an artificial kidney therapy known as Continuous Renal Replacement Therapy (CRRT). CRRT requires the establishment of a blood filled circuit (tubing) to enable the pumping of blood through an artificial kidney (also called a filter). This artificial kidney system often fails to work because blood clotting occurs. Ideally, this artificial kidney should function without clotting for at least 24 hours. Some recent clinical observations and studies have suggested that premature clotting of the circuit may be due to interruption to blood flow by mechanical factors such as the position of the vascular access device, patient movement and positional changes. These mechanical factors cause reductions in blood flow or cessation of blood flow. This reduction in blood flow causes blood flow stasis promoting clot formation and eventual circuit failure. There is great variability in the setting for the speed of the blood (blood flow rate) through the circuit amongst ICU’s in Australia. The blood flow rate may be influential in the promotion of clotting due to the mechanical factors described earlier. We proposed to make some comparisons between two blood flow rates (150 mL/min vs. 250 mL/min) currently being used within the ICU at Austin Health. The aim of this audit is to prospectively collect information and identify any advantage (if any) of one particular blood flow rate setting over another. This pilot and feasibility study completed data collection in Feb, 2015. Statistical analysis has required more advanced support than originally anticipated but is now complete. Only preliminary study results have been disseminated via presentation at the Annual Scientific Meeting of Intensive Care in Auckland.
Interventions
This project sought to investigate the impact of blood flow rate on filter (circuit) life in patient’s treated with continuous renal replacement therapy (CRRT) - a type of artificial renal support in the intensive care unit (ICU). This study was a randomised controlled trial, conducted in a single tertiary centre, with a 20 bed ICU. Data was collected over one year duration with the intention of enrolling 100 critically ill patients diagnosed with acute kidney injury (AKI) and being treated wit
This project sought to investigate the impact of blood flow rate on filter (circuit) life in patient’s treated with continuous renal replacement therapy (CRRT) - a type of artificial renal support in the intensive care unit (ICU). This study was a randomised controlled trial, conducted in a single tertiary centre, with a 20 bed ICU. Data was collected over one year duration with the intention of enrolling 100 critically ill patients diagnosed with acute kidney injury (AKI) and being treated with CRRT as part of their routine care. Patients treated with CRRT as prescribed by the treating ICU physician would be randomised to either of two groups. The two intervention groups are a blood flow rate of 150 mL/min or 250 mL/min. Once allocated to either intervention the patients would remain allocated to that intervention arm for the duration of time they were treated with artificial renal support or CRRT in the ICU. The decision to cease CRRT therapy was at the sole discretion of the treating ICU physician. Patients who had had therapy ceased for native renal assessment but required re-intervention at a later time in the ICU would remain randomised into the intervention group allocated and treated with CCRT as instructed by the ICU physician. The procedure for CRRT was standard as for all patients requiring renal support in the ICU. Devices or CRRT machines used were also those used in standard care for renal support. The machines used for this study were the Baxter Gambro Prismaflex and the Infomed HF440 haemofiltration machines.The therapy and the intervention are prescribed by the ICU physician and the practical application of the therapy and the intervention (blood flow rate)is administered by the bedside ICU nurse caring for the patient. The outcome variable for the study was circuit life (hours before clotting of the blood filled circuit).
Sponsors
Nigel Fealy
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients who have Developed AKI in accordance with the RIFLE classification (F) (grades of severity of AKI based on changes to serum creatinine and urine output and two clinical outcomes Require Continuous Renal Replacement Therapy (CRRT) as prescribed by the treating intensive care physician
Exclusion criteria
Patients who are anticipated to require a short stay in ICU; less than 24 hrs and or are expected to die in less than 24 hrs from ICU admission
Outcome results
None listed