Diagnosis Accuracy of Hemoconcentration to Detect Hypovolemia During CRRT

Study Overview
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Brief Summary
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The aim of the study is to analyze if blood protein concentration variation during continuous renal replacement therapy (CRRT) with fluid removal can predict a decrease of 15 % of cardiac index in intensive care unit (ICU) patients. Blood protein concentration, clinical data describing hemodynamic status (providing data from Pulsion medical system PiCCO2 ® monitoring), including preload dependency evaluation with passive leg raising, are collected at different times: before initiation of fluid removal, and after the first episode of hypotension or one hour after initiation of fluid removal.

Detailed Description
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The aim of the study is to analyze if blood protein concentration variation during continuous renal replacement therapy (CRRT) with fluid removal can predict a decrease of 15 % of cardiac index in intensive care unit (ICU) patients. Blood protein concentration, clinical data describing hemodynamic status (providing data from Pulsion medical system PiCCO2 ® monitoring), including preload dependency evaluation with passive leg raising, are collected at different times: before initiation of fluid removal, and after the first episode of hypotension or one hour after initiation of fluid removal.

Official Title
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Is Variation of Plasmatic Protein Concentration During Continuous Renal Replacement Therapy Predictive of Hypovolemia in Intensive Care Unit?

Conditions
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Hypovolemia, Continuous Renal Replacement Therapy, Intensive Care Unit, Fluid Overload

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: up to 18 years old continuous renal replacement therapy Suspicion of fluid overload Prescription of fluid removal by the intensivist PICCO2 monitoring Exclusion Criteria: pregnancy intra abdominal hypertension Moribund patient Abdominal hypertension

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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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| plasmatic protein concentration variation | Two sample of plasmatic protein before and after a fluid removal will be performed. The variation of the protein concentration (computed as the difference between final and baseline value divided by the baseline value expressed in %) will be the index test to diagnose a decrease of cardiac output of more than 15 % due to the fluid removal. | 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Plasmatic protein concentration in patient with preload dependency before fluid removal | hemoconcentration will be evaluated in the subgroup of preload dependent patients | 1 hour | 
| Central venous pressure (CVP) | CVP will be tested to evaluate the diagnostic ability to diagnose a reduction of cardiac output due the fluid removal | 1 hour | 
| Global end diastolic volume (GEDV) | GEDV, calculated with transpulmonary thermodilution will be tested to evaluate the diagnostic ability to diagnose a reduction of cardiac output due the fluid removal | 1 hour | 
| Extravascular lung water (EVLW) | EVLW, calculated with transpulmonary thermodilution will be tested to evaluate the diagnostic ability to diagnose a reduction of cardiac output due the fluid removal | 1 hour | 
| hemoconcentration evaluated with hemoglobin variation | hemoconcentration evaluated with hemoglobin variation will be tested to evaluate the diagnostic ability to diagnose a reduction of cardiac output due the fluid removal | 1 hour |