Does Bio-impedance Analysis Predict Volume Overload States and Clinically Relevant Outcomes in Septic Intensive Care Unit (ICU) Patients With Acute Kidney Injury? A Prospective Observational Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 55
- 试验地点
- 1
- 主要终点
- Ventilator free days
研究概览
简要总结
Patients with severe infections initially require large amounts of fluid as part of resuscitation. Later on however, problems may arise from excess fluid such as increased time on a ventilator and kidney damage. The amount of fluid a patient has is difficult to assess. One approach is to determine the amount of fluid that is present in a large central vein. This can be done by physical examination of the jugular veins, or by placing a catheter within the vein. Unfortunately this method is unreliable and does not predict the amount of fluid a patient has.
Bioimpedance analysis (BIA), is a device that can determine the amount of fluid in the body by measuring the body's electrical properties. It is a quick and painless test that assesses volume. The primary objective of this study is to determine if BIA measurements are associated with patient important outcomes such as time on a ventilator, risk of kidney failure requiring dialysis and death. We will also determine whether BIA is a measure of fluid status in ICU patients. This study will assess feasibility in establishing a multi-centre study assessing if BIA's role in predicting adverse outcomes and thereby prognosis and fluid status. We hypothesize that shorter vector lengths will be associated with hypervolemia and less ventilator free days.
详细描述
Overall Objective: Persistent hypervolemia following the initial resuscitative phase in sepsis has been shown to predict morbidity and mortality. In patients with sepsis in the intensive care unit (ICU) fluid accumulation is associated with a significant increase in duration of ventilation, development of acute kidney injury (AKI) requiring dialysis and increased ICU length of stay. It is essential to be able to identify and characterize the transition from necessary fluid resuscitation to harmful fluid volume accumulation. However, current methods for assessing volume status in the ICU are imprecise. Bioelectric impedance analysis (BIA) offers a well established and easy to perform bedside technique of volume assessment. Our main objective is to prospectively determine if bio-impedance derived measures are associated with patient important outcomes including ventilator free days, AKI requiring dialysis and overall mortality in septic ICU patients. In addition, we will also assess whether BIA derived measures of volume are associated with other measures of volume status.
Hypothesis #1: Bio-impedance derived measures (phase angle, vector length) will be predict ventilator-free days by day 30 and a composite outcome of ICU patients with AKI requiring dialysis and overall mortality .
Aim #1: To assess whether a change in bio-impedance vector length (a measure of volume status) between day 3 and day 7 post- admission to the ICU predicts ventilator-free days by day 30. Secondary outcomes are mortality, AKI and length of stay in ICU.
Hypothesis #2: BIA derived volume measures (vector length and the RXc graph method) will be associated with other clinical, invasive and biochemical measures of volume status
Aim #2: To determine if BIA derived volume measures are associated with other measures of volume status including central venous pressure, N- brain natriuretic peptide (N-BNP) and physical examination findings.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •adult patients
- •high clinical suspicion for infection
- •require positive pressure ventilation
- •supraclavicular central line for central venous pressure measurement
排除标准
- •Substitute decision maker unable to consent
- •amputation
- •pacemaker
- •require longterm hemodialysis
结局指标
主要结局
Ventilator free days
时间窗: 30 days
次要结局
- Correlation of BIA vector length with Central venous pressure, edema score, chest x-ray score, and net fluid balance(Time of enrollment (multivariate analysis at day 2 ))
- Acute Kidney Injury(60 days)
- Time until ICU discharge(60 days)
- Mortality(60 days)
研究者
Azim Gangji
principal investigator
St. Joseph's Healthcare Hamilton