The Influence of Fluid Removal Using Continuous Venovenous Hemofiltration (CVVH) on Intra-abdominal Pressure and Kidney Function
- Conditions
- Critically IllIntra-Abdominal HypertensionAbdominal Compartment SyndromeAcute Kidney Injury
- Interventions
- Procedure: CVVHProcedure: ultrafiltrationProcedure: ultrafiltration control group
- Registration Number
- NCT01077895
- Lead Sponsor
- University Hospital, Ghent
- Brief Summary
Intra- abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are a cause of organ dysfunction in critically ill patients. IAH develops due to abdominal lesions (primary IAH) or extra-abdominal processes (secondary IAH). Secondary IAH arises due to decreased abdominal wall compliance and gut edema caused by capillary leak and excessive fluid resuscitation. Decreasing intra-abdominal pressure (IAP) using decompressieve laparotomy has been shown to improve organ dysfunction. However, laparotomy is generally avoided in patients with secondary IAH due to the risk of abdominal complications.
Acute kidney injury (AKI) is one of the first and most pronounced organ failures associated with IAH and many patients with AKI in the ICU require renal replacement therapy (RRT). Fluid removal using continuous RRT (CRRT) has been demonstrated to decrease IAP in small series and selected patients.
The aim of this study is to evaluate whether fluid removal using CVVH in patients with IAH, fluid overload and AKI is feasible and whether it has a beneficial effect on organ dysfunction (compared to CVVH without net fluid removal).
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Adult patients (>18y old) of either gender
- Admitted to the ICU
- Sedated and mechanically ventilated (and expected to remain so for at least 48h)
- Informed consent given
- admitted to the ICU for <7 days or during the first 7 days of a new shock episode
- AKI requiring RRT according to treating physician
- IAP >12mmHg being attributed to fluid overload by treating physician
- Included in the same study before
- Vasopressor and/or inotrope dose needed above noradrenaline 1µg/kg/min and dobutamine 10µg/kg/min
- PaO2/FiO2 ratio <100
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description CVVH with fluid removal CVVH - CVVH without fluid removal CVVH - CVVH with fluid removal ultrafiltration - CVVH without fluid removal ultrafiltration control group -
- Primary Outcome Measures
Name Time Method Change in IAP in patients receiving fluid removal during CVVH vs patients receiving CVVH without net fluid removal after 24 and 48h of CVVH treatment 24 and 48 hours
- Secondary Outcome Measures
Name Time Method Difference between both groups in terms of daily fluid balance during 7 days Difference between both groups regarding mortality (28d, ICU and hospital) and ICU and hospital length of stay 28 days and length of stay in ICU and hospital The relationship between cumulative fluid balance at the start of each day of CVVH and the fluid balance achieved after 24h of CVVH with fluid removal 24 hours Difference between CVVH with fluid removal and CVVH without fluid removal after 24 hours and/or 7 days Difference in terms of
* Need for vasopressor medication and hemodynamic parameters during the first seven days
* PaO2/FiO2 (worst value over 24h daily first 7 days)
* Volume of albumin solution or synthetic colloids administered during CVVH per 24h
* SOFA score daily first seven days
* Need for decompressive laparotomy or other means to decrease IAP
* Acid-base status
* Complications relating to ischemiaDifference between both groups regarding recovery of renal function, need for RRT at discharge from the ICU and from the hospital discharge from ICU and hospital
Trial Locations
- Locations (2)
University Hospital Ghent
🇧🇪Ghent, Belgium
ZNA Stuivenberg Hospital
🇧🇪Antwerp, Belgium