Protocolised Early De-Resuscitation in Septic Shock (REDUCE) - a Randomised Controlled Multi-centre Feasibility Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Septic Shock
- Sponsor
- Insel Gruppe AG, University Hospital Bern
- Enrollment
- 170
- Locations
- 4
- Primary Endpoint
- Proportion of patient with a negative fluid balance on day 3
- Status
- Active, not recruiting
- Last Updated
- last year
Overview
Brief Summary
Background: Recent studies have questioned the safety of current fluid resuscitation strategies in patients with septic shock as prospective and observational data suggesting that the resulting fluid overload is associated with mortality. Two strategies have evolved to prevent or minimize fluid overload: restrictive fluid administration or active removal of accumulated fluid. While several small trials show benefits with a restrictive fluid administration regimen, active protocolized de-resuscitation was scarcely evaluated. The combination of both strategies yet warrants systematic evaluation.
Aim: This study aims to assess the efficacy and feasibility of an early active de-resuscitation protocol in patients with septic shock. We hypothesize that the application of a structured early de-resuscitation protocol versus standard of care will lead to less fluid overload at day three after ICU admission.
Study Intervention: Patients admitted to the ICU with confirmed or suspected septic shock (Sepsis-3 definition) will be randomized (1:1) to either the intervention or standard of care. In the intervention arm, patients are managed according to the REDUCE fluid management protocol during resuscitation and de-resuscitation.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients admitted to ICU with the diagnosis of septic shock as defined according to the Sepsis-3 criteria (suspected or confirmed infection AND vasopressor/inotrope ongoing to maintain MAP ≥ 65 mmHg AND Lactate ≥ 2 mmol/l in the last 6 hours
Exclusion Criteria
- •Age \<18 years
- •Septic shock for more than 12 hours at the time of screening
- •Acute burn injury \>/= 10% of the body surface area
- •Known pregnancy or lactating women
- •Consent not obtainable due to national legislation
- •Patients on chronic dialysis
- •Patients that are known to be allergic to furosemide or metolazone
Outcomes
Primary Outcomes
Proportion of patient with a negative fluid balance on day 3
Time Frame: Up to day 3 after ICU admission
Proportion of patients with a negative cumulative fluid balance on day 3
Secondary Outcomes
- Vasopressor-free days at day 30(Up to 30 days after randomisation)
- Ventilator-free days at day 30(Up to 30 days after randomisation)
- All-cause mortality(Up to 90 days after randomisation)
- Number of patients with fluid overload at day 3 and ICU discharge(From hospital admission to the end of ICU stay, on average after 7 days)
- Number of patients with need for renal replacement at 90days(Up to 90 days after randomisation)
- Feasibility of the REDUCE fluid protocol(From randomisation until the end of ICU stay, on average after 7 days)
- Incidence of ischemic events and severe AKI(Ischemic events and AKI: From randomisation until the end of ICU stay (on average after 7 days), and at day 30; electrolyte and acid-base/medication associated safety endpoints: during ICU stay (on average 7 days))
- Renal replacement therapy(Up to 90 days after randomisation)