Effects of Fluid Balance Control in Critically Ill Patients

Status Completed

Clinical Trial Summary

Most ICU patients develop a positive fluid balance, mainly during the two first weeks of their stay. The causes are multifactorial: a reduced urine output subsequent to shock state, positive pressure mechanical ventilation, acute renal failure, post-operative period of major surgical procedures, and simultaneous fluid loading to maintain volemia and acceptable arterial pressure. Additionally, the efficacy of fluid loading is frequently suboptimal, in relation to severe hypoalbuminemia and inflammatory capillary leakage. This results usually in a cumulated positive fluid balance of more than 10 litres at the end of the first week of stay. A high number of studies have showed that such a positive fluid balance was an independent factor of worse prognosis in selected populations of ICU patients: acute renal failure, acute respiratory distress syndrome (ARDS), sepsis, post-operative of high risk surgery. However, little is known about the putative causal role of positive fluid balance by itself on outcome. However, in two randomized controlled studies in patients with ARDS, a strategy of fluid balance control has been demonstrated to reduce time under mechanical ventilation and ICU length of stay with no noticeable adverse effects. Although avoiding fluid overload is now recommended in ARDS management, there is no evidence that this approach would be beneficial in a more general population of ICU patients (i.e. with sepsis, acute renal failure, mechanical ventilation). In addition, fluid restriction -mainly if applied early could be deleterious in reducing both tissue oxygen delivery and perfusion pressure. There is a place for a prospective study comparing a "conventional" attitude based on liberal fluid management throughout the ICU stay with a restrictive approach aiming at controlling fluid balance, at least as soon as the patient circulatory status is stabilized. The latter approach would use a simple algorithm using fluid restriction and diuretics based on daily weighing, a common procedure in the ICU, probably more reliable than cumulative measurement of fluid movements in patients whose limits have been underlined.

Clinical Trial Description

n/a

Study Design

Related Conditions & MeSH terms

Clinical Trial Details

NCT number	NCT02765009
Study type	Interventional
Source	Central Hospital, Nancy, France
Contact
Status	Completed
Phase	N/A
Start date	June 1, 2016
Completion date	May 25, 2020

View Details

See also
Status	Clinical Trial	Phase
Recruiting	`NCT05114551` - ICU Predictive Score of WEaning Success in Patients At Risk of Extubation Failure
Completed	`NCT05547646` - The Prevalence of Healthcare-associated Infection in Medical Intensive Care Units in Tunisia
Recruiting	`NCT03697785` - Weaning Algorithm for Mechanical VEntilation	N/A
Completed	`NCT02922101` - Evaluation of the Effectiveness of an Audit and Feedback Intervention With Quality Improvement Toolbox in Intensive Care	N/A
Completed	`NCT02902783` - DONATE-Pilot Study on ICU Management of Deceased Organ Donors
Completed	`NCT01857986` - Evaluating Air Leak Detection in Intubated Patients	N/A
Completed	`NCT01885442` - TryCYCLE: A Pilot Study of Early In-bed Leg Cycle Ergometry in Mechanically Ventilated Patients	N/A
Recruiting	`NCT05518955` - VR Integrated Into Multicomponent Interventions for Improving Sleep in ICU	N/A
Recruiting	`NCT03810768` - Metabolomics Study on Postoperative Intensive Care Acquired Muscle Weakness
Completed	`NCT03295630` - Validity of an Actigraph Accelerometer Following Critical Illness	N/A
Completed	`NCT05556811` - HEaling LIght Algorithms for the ICU Patient	N/A
Recruiting	`NCT05702411` - Air Stacking Technique For Pulmonary Reexpansion	N/A
Completed	`NCT02741453` - Bilateral Internal Jugular Veins Ultrasound Scanning Prior to CVC Placement	N/A
Recruiting	`NCT04979897` - Impact on Mental, Physical, And Cognitive Functioning of a Critical Care sTay During the COVID-19 Pandemic
Completed	`NCT05281224` - Ventilator Tube Holder for Patients With a Tracheostomy
Withdrawn	`NCT02970903` - VitalPAD: an Intelligent Monitoring and Communication Device to Optimize Safety in the PICU	N/A
Recruiting	`NCT02587273` - The Pharmacokinetics of Fentanyl in Intensive Care Patients	Phase 4
Completed	`NCT02661607` - Point of Care Echocardiography Versus Chest Radiography for the Assessment of Central Venous Catheter Placement	N/A
Completed	`NCT01479153` - Venous Site for Central Catheterization	N/A
Recruiting	`NCT06110390` - High-flow Nasal Oxygen Therapy to Prevent Extubation Failure in Adult Trauma Intensive Care Patients	N/A

Clinical trials are conducted in a series of steps, called phases - each phase is designed to answer a separate research question.

Phase 1: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
Phase 2: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.
Phase 3: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
Phase 4: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.

Effects of Fluid Balance Control in Critically Ill Patients — POINCARE

Clinical Trial Summary

Clinical Trial Description

Study Design

Related Conditions & MeSH terms