Regional Citrate Anticoagulation, Ionized Calcium, Continuous Renal Replacement Therapy
Conditions
Keywords
Regional citrate anticoagulation, Ionized calcium, Continuous Renal Replacement Therapy
Brief summary
Do no monitor of post-circuit ionized calcium affact the filter life time of continueous renal replacement therapy with regional citrate anticoagulation circuit? A randomized control trial
Detailed description
Regional citrate anticoagulation is the gold standard of anticoagulation in patient receiving CRRT. In RCA circuit, there was a monitoring of pre-filter (systemic) ionized calcium and post-filter (circuit) ionized calcium. Pre-filter ionized calcium was monitored for observe the adverse effect of citrate such as hypocalcemia, citrate intoxication. However, post-filter ionized calcium was monitored for adjustment the citrate dose. We find many problem with frequently monitoring of post-ionized calcium such as confusion from markedly abnormal result, how to adjustment the citrate dose ,and increase workload for nurses. We hypothesis that if we can monitoring of post-filter ionized calcium?
Interventions
Starting RCA 4 mmol/L (adjust the rate by BFR)
DRUGVasopressor
Vasopressors such as Norepinephrine, dopamine, milrinone, dobutamine
DRUGAntibiotic
Antibacterial agents deemed appropriate by physicians in the ICU
Prismaflex
Sponsors
Chulalongkorn University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Caregiver)
Masking description
Masking of post-filter ionized calcium result in no-monitoring arm
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age older than 18 years old and admission in an ICU * Indication for CRRT * regional citrate anticoagulation
Exclusion criteria
* Acute liver failure defined as AST or ALT \> 5X UNL or TB/DB \> 5X UNL or evidence of cirrhosis * Severe persistent lactic acidosis (lactate persist \> 8 mg/dL consecutively within 6 hours) * Receiving heparin anticoagulation * Severe alkalosis (pH\>7.55) or acidosis (pH\<7.1) * History of renal allograft * Known pregnancy * Patient is moribund with expected death within 24 hr * Deficiency of ionzed calcium (Cation \< 0.8 mmol/L)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Filter lifetime in hours | 72 hours | How long with filter with RCA |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Circuit downtime in hours | 72 hours | Circuit downtime during CRRT with RCA |
| Cost per treatment in Baht | 72 hour | Cost of CRRT include laboratory in Baht |
| Citrate accumulation | 72 hours | Number of total calcium to ionized calcium ratio \> 2.5 |
| Efficacy of CRRT | 72 hours | Seiving coefficient of urea and difference of prescribed dose of CRRT |
| Citrate dose | 72 hours | Average citrate dose |
| Adverse event | 72 hours | adverse event of RCA |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change of Hct | 72 hours | Rate of Hct change from from baseline to end of the study |
| Change of electrolyte | 72 hours | Rate of electrolyte change from baseline to end of the study |
| Change of APACHE II score | 72 hours | Change of APACHE II score (Use the worst value in 24 hour)from baseline to end of the study |
| Change of SOFA scores | 72 hours | Change of SOFA Scores (Use the worst value in 24 hour) from baseline to end of the study |
Countries
Thailand
Outcome results
None listed