Fluid Overload, Kidney Injury, Make-30
Conditions
Brief summary
Fluid resuscitation is one of the cornerstones of treatment in ICU patients. Nonetheless, excessive fluid administration can lead to fluid overload which has been associated with worse outcomes in the ICU. To prevent this, assessments of fluid responsiveness are commonly employed. However, fluid responsiveness does not take fluid tolerance into account. Fluid tolerance is the idea that a patient might still be fluid responsive but might already be at risk of the detrimental effects of fluid therapy. Recent developments in point of care ultrasound e.g. the Venous excess ultrasound might help identify patients at risk of fluid overload. However its association with patient relevant outcomes in the ICU remains unclear.
Detailed description
This study will investigate the association between the venous excess ultrasound grading system (VExUS) and patient relevant outcomes such as acute kidney injury, mortality and length of stay. A secondary analysis is planned where the association between VExUS and the lung ultrasound score will be investigated
Interventions
None listed
Sponsors
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* all patients admitted to the ICU 18 years or older expected to stay in the ICU for more than 24 hours
Exclusion criteria
* any obstruction between the righ atrium and structures assessed by VExUS * a medical history of: Major cardiac shunts (e.g. atrial septum defect), Tricuspid regurgitation, dialysis, portal hypertension, pulmonary hypertension, interstitial lung disease, recipients of a kidney of liver transplant. * patients in whom an ultrasound assesment is unfeasible e.g. a BMI over 40
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of acute kidney injury | within 30 days of admission to the ICU | Clinically relevant acute kidney injury in the ICU: a 200% rise in creatinine or the use of renal replacement therapy |
| Mortality | within 30 days of admission to the ICU | death of all causes |
| Rate of MAKE-30 | within 30 days of admission to the ICU | a composite endpoint of mortality and acute kidney injury ( including renal replacement therapy) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Lung ultrasound score | maximum of 3 times during the first 7 days of admission | a score for lung aeration as assessed by ultrasound ranging from 0 to 36 where 0 is the normal physiological state |
| Cardiac function as assed by ultrasound | maximum of 3 times during the first 7 days of admission | determined by eyeballing and measurement of the tricuspid annular plane systolic excursion (\>16 is normal) |
Countries
Netherlands
Contacts
Primary ContactPieter R Tuinman, PhD
Backup ContactP Klompmaker, MSc
Outcome results
None listed