Volume Kinetics of Fluid Resuscitation in Early Sepsis
Volume Kinetics of Fluid Resuscitation With 30 ml/kg Ringer Lactate in Early Sepsis
Institutul de Urgenţă pentru Boli Cardiovasculare Prof.Dr. C.C. Iliescu
15 participants
Jun 19, 2024
OBSERVATIONAL
Conditions
Summary
The recommended volume resuscitation for patients with early sepsis-induced hypoperfusion is at least 30 ml/kg of crystalloid administered within the first three hours. However, this standardized approach does not account for individual patient variability and lacks personalization. Additionally, the effects of administering 30 ml/kg on intercompartmental fluid shifts between the plasma and interstitial compartments remain unclear. This study aims to describe the volume kinetics of administering 30 ml/kg of Ringer's Lactate in patients with early sepsis-induced hypoperfusion within the first three hours.
Eligibility
Inclusion Criteria6
- A diagnosis of sepsis, as defined by the Sepsis-3 criteria and exhibiting sepsis-induced hypoperfusion prior to the administration of adequate volume resuscitation:
- hypotension requiring norepinephrine to maintain a mean arterial blood pressure (MAP) either predefined by the clinician or at 65 mm Hg or higher and/or
- a serum lactate level \>2 mmol/L (18mg/dL) and/or
- acute oliguria defined as urine output \<0.5mL/kg/hr and/or
- mottled skin and/or
- capillary refill time \> 3 seconds.
Exclusion Criteria11
- Administration of at least 1 L of IV fluid in the last 6 hours prior to screening. All crystalloids, colloids and blood products that the patient has received are counted.
- Known pregnancy.
- Competing causes of lactic acidosis including: seizures within 3 hours of enrollment, use of linezolid or metformin or anti-retrovirals at the time of enrollment, carbon monoxide or cyanide poisoning, highly suspected or known ischemic bowel, and known mitochondrial disorders.
- End-stage renal disease that requires chronic dialysis.
- Concurrent haemorrhagic or obstructive shock.
- Increased risk of fluid intolerance:
- Echocardiographic evidence of moderate or severe left ventricular systolic dysfunction.
- Echocardiographic evidence of moderate or severe right ventricular systolic dysfunction.
- Hypoxemia index \< 200 mmHg or sonographic evidence of bilateral B or C profile.
- Abdominal compartment syndrome.
- Post-cardiac arrest.
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Interventions
Ringer's Lactate is administered at a dose of 30ml/kg, with the first 20ml/kg given at a constant rate over the initial 30 minutes, followed by a 30-minute pause, and then an additional 10ml/kg over the next 15 minutes, completing the infusion within 75 minutes.
Locations(2)
View Full Details on ClinicalTrials.gov
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NCT06499701