The Influence of Furosemide on Fluid Balance and Intra-abdominal Pressure in Critically Ill Patients

The recruitment status of this study is unknown because the information has not been verified recently.
Verified February 2010 by Ziekenhuis Netwerk Antwerpen (ZNA).
Recruitment status was  Recruiting
Sponsor:
Information provided by:
Ziekenhuis Netwerk Antwerpen (ZNA)
ClinicalTrials.gov Identifier:
NCT01072071
First received: February 18, 2010
Last updated: February 19, 2010
Last verified: February 2010
  Purpose

Intra-abdominal hypertension (IAH) is a frequent cause of organ dysfunction in critically ill patients. Secondary IAH is mainly caused by excessive fluid resuscitation.The World Society for the Abdominal Compartment Syndrome (WSACS) recommends using diuretics to remove excess fluids and decrease intra-abdominal pressure (IAP). However, critically ill patients may not tolerate negative fluid balance in the acute phase of their disease and the injured kidney may not respond to diuretics. The aim of this study is to evaluate the influence of furosemide on fluid balance, IAP and kidney function in critically ill patients.


Condition Intervention
Intra-Abdominal Hypertension
Drug: furosemide

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Treatment
Official Title: The Influence of Furosemide on Fluid Balance and Intra-abdominal Pressure in Mechanically Ventilated Critically Ill Patients With Secondary Intra-abdominal Hypertension

Resource links provided by NLM:


Further study details as provided by Ziekenhuis Netwerk Antwerpen (ZNA):

Primary Outcome Measures:
  • intra-abdominal pressure [ Time Frame: every 4 hours during furosemide administration and daily for 7 days ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • serum creatinine [ Time Frame: daily for 7 days ] [ Designated as safety issue: Yes ]
  • need for renal replacement therapy [ Time Frame: daily for 7 days ] [ Designated as safety issue: Yes ]
  • ICU mortality [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
  • acid-base status [ Time Frame: daily for 7 days ] [ Designated as safety issue: Yes ]
  • hospital and 28d mortality [ Time Frame: after 28 days and after 6 months ] [ Designated as safety issue: Yes ]
  • duration of mechanical ventilation [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  • ICU length of stay [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  • vasopressor dose [ Time Frame: daily for 7 days ] [ Designated as safety issue: Yes ]
  • fluid balance [ Time Frame: daily for 7 days ] [ Designated as safety issue: No ]
  • SOFA score [ Time Frame: daily for 7 days ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 30
Study Start Date: February 2010
Estimated Study Completion Date: March 2012
Estimated Primary Completion Date: December 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: Control group
Patients will be receiving standard of care ICU treatment of their underlying disease according to internationally accepted guidelines and recommendations.
Experimental: Furosemide group
patients will be receiving standard of care ICU treatment of their underlying condition according to international guidelines and recommendations. In addition, furosemide will be administered in continuous infusion as per protocol in order to achieve a preset target diuresis that is adjusted according to haemodynamic tolerance.
Drug: furosemide

Loading dose: 0,5mg/kg Start continuous infusion at a dose of 0,1mg/kg/h and titrate according to diuretic response.

Target value for diuresis = (amount of fluids administered at inclusion/kg/h) + 0.5mL/kg/h If safety check is satisfactory: increase target diuresis with 1mL/kg/h per 4h to a maximum of (amount of fluids administered at inclusion/kg/h) + 2.5mL/kg/h Maximal dose of furosemide: 0.3mg/kg/h Safety check every 4h. Furosemide is administered for 24h. If safety checks are satisfactory, additional periods of 24 can be added up to a maximum of 72h.

Other Name: Lasix (Sanofi-Aventis)

Detailed Description:

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been shown to cause organ dysfunction and mortality in different populations of critically ill patients. According to consensus definitions published by the World Society for the Abdominal Compartment Syndrome (WSACS), secondary IAH is due to a disease process outside the abdominal cavity. It is mainly caused by massive fluid resuscitation leading to bowel and abdominal wall edema or increased intra-abdominal volume and decreased abdominal wall compliance. Large observational studies have shown that positive fluid balance is an independent risk factor for mortality. The development of secondary IAH may be one of the mechanisms involved in this phenomenon. This has lead to the hypothesis that prognosis may be improved by managing fluid overload and aiming for a negative fluid balance as soon as possible after the resuscitation phase of the disease.

Several authors have shown in case reports and small series that renal replacement therapy with ultrafiltration can be used successfully to remove excess fluid and lower intra-abdominal pressure (IAP), but renal replacement therapy is invasive and clinicians may be reluctant in considering this therapy in patients with preserved diuresis and kidney function. In an effort to achieve the same goal using a less invasive technique, the new medical management algorithm for IAH published by the WSACS recommends the use of judicious diuresis in order to achieve a negative fluid balance and a decrease in IAP.

However, the kidney is especially sensitive to the deleterious effects of IAH and may be unresponsive to diuretics in the presence of IAH. Also, ongoing inflammation and capillary leak may lead to relative hypovolemia and impaired response to diuretics.

We plan a multicenter study to evaluate the influence of furosemide on fluid balance and IAP in critically ill patients with secondary intra-abdominal hypertension and to document the effect on the function of other organ systems. The aim of this study is to evaluate the feasibility and the safety of the furosemide administration protocol and to provide preliminary data to allow for an adequate power calculation.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Adult (>18y)
  • Sedation (Richmond Agitation and Sedation Score RASS ≤ -3) and mechanical ventilation anticipated to last for at least an additional 72h
  • Indication for IAP monitoring according to the recommendations published by the WSACS
  • IAP ≥ 12mmHg (intravesical IAP measurement according to WSACS guidelines)
  • Absence of surgically treatable abdominal lesions
  • Presence of fluid overload

Exclusion Criteria:

  • Pregnancy or lactation
  • Assisted spontaneous breathing ventilator mode
  • Chronic diuretic therapy or on diuretics during inclusion
  • Contra-indication to bladder catheterization such as bladder surgery or genitourinary trauma
  • Known hypersensitivity to furosemide
  • Renal failure Acute Kidney Injury Network (AKIN) class 3
  • Patients requiring high dose vasopressors (norepinephrine >0.5µg/kg/min, dobutamine >10µg/kg/min or dopamine>10µg/kg/min, epinephrine>0.5µg/kg/min)
  • Intra-abdominal pressure (IAP) >25mmHg at study entry
  • DNR orders in effect (other than DNR 1 'no CPR' order)
  • Patient not expected to survive for 7 days
  • Advanced liver cirrhosis (see pharmaceutical information on furosemide)
  • paO2/FiO2 ratio of <100
  • oliguria <500mL/24h preceding inclusion
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01072071

Contacts
Contact: Inneke E De laet, MD +32476216120 inneke.delaet@zna.be
Contact: Manu Malbrain, MD PhD +3232177399 manu.malbrain@zna.be

Locations
Belgium
ZNA Stuivenberg Intensive Care Unit Recruiting
Antwerpen, Belgium, 2060
Contact: Inneke E De laet, MD    +32476216120    inneke.delaet@zna.be   
Contact: Manu Malbrain, MD PhD    +3232177399    manu.malbrain@zna.be   
Sponsors and Collaborators
Ziekenhuis Netwerk Antwerpen (ZNA)
  More Information

Additional Information:
No publications provided

Responsible Party: Inneke De laet MD, ZNA Stuivenberg, Intensive Care Unit
ClinicalTrials.gov Identifier: NCT01072071     History of Changes
Other Study ID Numbers: IDL2009/003
Study First Received: February 18, 2010
Last Updated: February 19, 2010
Health Authority: Belgium: Institutional Review Board
Belgium: Ministry of Social Affairs, Public Health and the Environment

Keywords provided by Ziekenhuis Netwerk Antwerpen (ZNA):
abdominal compartment syndrome
intra-abdominal pressure
furosemide
fluid balance

Additional relevant MeSH terms:
Critical Illness
Hypertension
Intra-Abdominal Hypertension
Disease Attributes
Pathologic Processes
Vascular Diseases
Cardiovascular Diseases
Compartment Syndromes
Muscular Diseases
Musculoskeletal Diseases
Furosemide
Diuretics
Natriuretic Agents
Physiological Effects of Drugs
Pharmacologic Actions
Sodium Potassium Chloride Symporter Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Cardiovascular Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on September 16, 2014