AKI - Acute Kidney Injury, AKI (Acute Kidney Injury) Due to Trauma, Traumatic Haemorrhagic Shock
Conditions
Brief summary
Acute kidney injury (AKI) is a complication of traumatic haemorrhagic shock (THS) and together these conditions increase mortality risk. Although septic shock patients who develop severe AKI are known to develop hypoperfusion of the renal cortex, little is known regarding intra-renal perfusion changes in THS. The aim of the current study is to investigate the effects of THS on renal microcirculatory perfusion.
Interventions
DEVICEUltrasound (including contrast enhanced ultrasound)
Ultrasound measures: contrast enhanced ultrasound (CEUS) of the kidney, venous excess ultrasound (VExUS), echocardiography
DEVICESublingual incident dark field videomicroscopy
Sublingual incident dark field (IDF) videomicroscopy
DEVICEUrinary oxygen tension.
Continuous urinary oxygen tension
Sponsors
King's College Hospital NHS Trust
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years * Within 24 hours of ICU admission following traumatic injury * Received any blood products during initial resuscitation * Lactate \> 2 mmol/l at any stage prior to study enrolment
Exclusion criteria
* Known intolerance to Sonovue or any other ultrasound contrast agent * Patients with un-survivable injuries / not expected to survive 24 hours in whom the intent of treatment is palliative * Known CKD 4 or end stage renal failure * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cortical mean transit time (mTT) measured in seconds | Measured at enrollment, +24 hours and + 48 hours | Contrast enhanced ultrasound measure of renal cortical tissue blood flow |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cortical perfusion index (PI) measured in arbitrary units | Measured at enrollment, +24 hours and + 48 hours | Contrast enhanced ultrasound measures of renal cortical tissue blood flow |
| Cortical wash in rate (WiR) measured in arbitrary units | Measured at enrollment, +24 hours and + 48 hours | Contrast enhanced ultrasound measures of renal cortical tissue blood flow |
| Urinary oxygen tension (pO2) across 24 hours study period measured in millimetres of mercury (mmHg) | Across 48 hour study period | Mean urinary pO2 |
Other
| Measure | Time frame | Description |
|---|---|---|
| Microvascular flow index (MFI) (unitless score from 0 to 3 where 3 is the value see in health) | Measured at enrollment, +24 hours and + 48 hours | Incident dark field video microscopy measures of the systemic microcirculation |
| Syndecan 1, angiopoietin 1 & 2, Interleukin 6 & 8 (IL-6, IL-8) and tissue necrosis factor (TNF). All measured in nanograms per millilitre (ng/ml) | Measured at enrollment and + 48 hours | Biomarker analysis - markers of inflammation and endothelial activation/function |
| Perfused vessel density (PVD) measured in millimetres per square millimetre | Measured at enrollment, +24 hours and + 48 hours | Incident dark field video microscopy measures of the systemic microcirculation |
Countries
United Kingdom
Contacts
Primary ContactSam Hutchings
Outcome results
None listed