Natriuresis-guided Depletion After Cardiac Surgery
Evaluation of Natriuresis-guided Depletion After Cardiac Surgery: a Monocentric, Open-label, Randomized Controlled Trial
Centre Hospitalier Universitaire, Amiens
102 participants
Jun 25, 2025
INTERVENTIONAL
Conditions
Summary
Fluid overload (FO) is a common complication after cardiac surgery, associated with increased morbidity and mortality. Loop diuretics, especially furosemide, are routinely used to manage FO, but their use is often empirical. Recent data suggest that natriuresis-guided furosemide titration using point-of-care urinary sodium sensors (LAQUAtwin NA-11, Horiba) may improve the efficiency and safety of fluid removal, but no randomized trial has yet evaluated this approach in postoperative cardiac surgery patients Our goal is to assess the clinical impact, safety, and feasibility of a natriuresis-guided furosemide protocol after cardiac surgery requiring cardiopulmonary bypass.
Eligibility
Inclusion Criteria6
- Adult patient (age > 18 years)
- Scheduled for cardiac surgery, including mitral valve repair or replacement, aortic valve replacement, coronary artery bypass grafting (CABG), ascending aortic repair, or combined procedures
- Undergoing surgery with cardiopulmonary bypass (CPB)
- Eligible to receive intravenous furosemide for fluid overload within 48 hours following surgery, as prescribed by the referring physician
- Written and oral informed consent obtained
- Covered by the French national health insurance (Sécurité Sociale)
Exclusion Criteria10
- Aortic arch repair requiring deep hypothermic circulatory arrest
- Active endocarditis
- Hemodynamic instability requiring vasopressor or inotropic support (norepinephrine, dobutamine, epinephrine, or vasopressin)
- Failure to wean from CPB requiring mechanical circulatory support
- Chronic kidney disease with an estimated glomerular filtration rate (eGFR) < 60 mL/min
- Chronic use of loop diuretics
- Known allergy to furosemide
- Active postoperative bleeding and/or reoperation for bleeding
- Participation in another interventional study that may affect the primary outcome measure
- Patient deprived of liberty by administrative or judicial decision, or placed under legal protection (guardianship or curatorship)
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Interventions
Furosemide IV, 20 mg starting dose, titrated every 6 hours based on urinary sodium measured by the LAQUAtwin NA-11 device. Urine output will be measured and recorded every 4 hours to ensure accurate diuresis tracking. If natriuresis is \< 70 mmol/L, the furosemide dose will be doubled, with a maximum limit of 200 mg per bolus. If natriuresis is ≥ 70 mmol/L, the current dose will be maintained. Blood electrolyte panels and renal function assessments will be performed twice daily throughout the protocol. In the event of hemodynamic instability, a complete echocardiographic assessment will be performed for all patients to detect potential surgical complications, along with a hemodynamic evaluation to guide appropriate management.
Furosemide IV, 20 mg starting dose, titrated every 6 hours clinical evaluation. Urine output will be measured and recorded every 4 hours to ensure accurate diuresis tracking. The furosemide dosage will be adjusted based on urine output with a maximum bolus dose of 200 mg. Dose adjustments will be reassessed every 6 hours throughout the study period. Blood electrolyte panels and renal function assessments will be performed twice daily throughout the protocol. In the event of hemodynamic instability, a complete echocardiographic assessment will be performed for all patients to detect potential surgical complications, along with a hemodynamic evaluation to guide appropriate management.
Locations(1)
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NCT07077772