Early Dry Cohort : Impact on the Fluid Balance of a Perfusion Based Protocol to Adjust UFnet During Deresuscitation in Intensive Care Unit.

Study Overview
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Brief Summary
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Fluid overload is frequent and associated with mortality in critically ill patients, especially those with acute kidney injury. If fluid loading is a cornerstone of a resuscitation strategy, some authors promote an evacuation phase to limit the fluid overload exposure (deresuscitation strategy). In patients with continuous renal therapy, often presenting an inadequate diuresis, it includes the net ultrafiltration setting. A potential side effect of deresuscitation strategy is to induce iatrogenic hypovolemia. We have implemented a perfusion-based protocol to induce systematic early fluid removal on patients after haemodynamic stabilization. We would like to observe the impact on the fluid balance of such a protocol and to explore the recruitment capacity of our centre and exploratory outcomes to lead a future randomized control study.

Official Title
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Impact on the Fluid Balance of a Perfusion Based Protocol to Adjust UFnet During Deresuscitation in Intensive Care Unit. A Before-after Study.

Conditions
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Acute Kidney Injury

Intervention / Treatment
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* Other: Early Dry protocol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Age ≥ 18 ans Acute kidney injury with continuous renal replacement therapy Fluid overload > 5% Equivalent Norepinephrine dose < 0,5 µg/kg/min Exclusion Criteria: - Chronic intermittent haemodialysis Active bleeding Stroke with coma Pregnancy advanced directives to withhold or withdraw life-sustaining treatment patient's opposition to the use of his/her personal health data.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| before protocol implementation<br>A control group reflecting usual practice about net ultrafiltration and deresuscitation strategy in patients with continuous renal replacement therapy in our Department. All patients meeting eligibility criteria between 01/01/2020 and 31/12/2021 will be include. | Other: Early Dry protocol<br>* After meeting eligibility criteria, patients have a net ultrafiltration of 2mL/kg/h with systematic perfusion monitoring (lactate concentration, central venous saturation, mottling score and capillary refill time) and restrictive input. If the patient presents hypoperfusion (at least to sign), net ultrafiltration is stopped and haemodynamic optimized. If the patient presents pulmonary oedema or right ventricular failure, with venous congestion, ultrafiltration is set at 3mL/kg/h. Ultrafiltration is set between 0.5 and 1mL/kg/h when the following criteria are fulfilled: weight inferior to the admission weight; central venous pressure inferior to 5mmHg; absence of clinical oedema. The haemodynamic status is reevaluated all six hours.<br>|
| after protocol implementation<br>All patients treated by our deresuscitation protocol between 15/02/2020 and 15/08/2021 will be included. | Other: Early Dry protocol<br>* After meeting eligibility criteria, patients have a net ultrafiltration of 2mL/kg/h with systematic perfusion monitoring (lactate concentration, central venous saturation, mottling score and capillary refill time) and restrictive input. If the patient presents hypoperfusion (at least to sign), net ultrafiltration is stopped and haemodynamic optimized. If the patient presents pulmonary oedema or right ventricular failure, with venous congestion, ultrafiltration is set at 3mL/kg/h. Ultrafiltration is set between 0.5 and 1mL/kg/h when the following criteria are fulfilled: weight inferior to the admission weight; central venous pressure inferior to 5mmHg; absence of clinical oedema. The haemodynamic status is reevaluated all six hours.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Computed cumulative fluid balance (mL) at day 5 after protocol onset. | Cumulative between input and output, defined as follow: Input = cumulative volume of: Medication Enteral and parenteral feeding Fluid loading Transfusion products Output = cumulative volume of: diuresis surgical drainage net ultrafiltration | Day 5 after protocol onset. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ultrafiltration, deresuscitation, fluid overload, fluid balance.