Hemofiltration in Burns: RESCUE (Randomized Controlled Evaluation of Hemofiltration in Adult Burn Patients With Septic Shock and Acute Renal Failure)

NCT ID: NCT01213914

Last Updated: 2018-04-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

37 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-08-31

Study Completion Date

2018-09-30

Brief Summary

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The purpose of this study is determine if High-Volume Hemofiltration in addition to 'contemporary' care will result in an improvement of select clinical outcomes when compared to 'contemporary' care alone in the treatment of critically ill patients with ARF secondary to septic shock.

Detailed Description

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Acute renal failure (ARF) is a common and devastating complication in critically ill burn patients with mortality reported to be between 80 and 100%.(3-7) Despite recent advances in burn care, the unacceptably high mortality rate in this subgroup has not changed over time. The pathogenesis of ARF in burns, similar to other critically ill populations, is often multi-factorial with one major component being sepsis induced ischemic tubular necrosis. Thus, ARF secondary to septic shock is a common and devastating condition in the burn ICU.

Conditions

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Burns Hemofiltration Kidney Failure, Acute Shock, Septic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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High-volume hemofiltration at 70ml/kg/hr

Paired randomization into four groups via central randomization center. Group 1: age 18-65 and \<40%TBSA Group 2: age 18-65 and \>40%TBSA Group 3: age \>65 and \<40%TBSA Group 4: age \>65 and \>40%TBSA

Group Type EXPERIMENTAL

An FDA approved continuous renal replacement device

Intervention Type DEVICE

70ml/kg/hr for treatment group for 48 hours with the following requirements:

* double lumen dialysis catheter should be placed in the internal jugular or femoral vein
* Anticoagulation will be determined by prescribing physician
* Use of 1.4 m2 or larger biocompatible synthetic hollow-fiber dialysis membrane that is changed every 24 hours
* Blood flow rate will be set to ensure a filtration fraction of no more than 25%
* Monitoring for electrolytes (specifically K+, Mg, Ca, and phos) during HVHF must be performed at least every 6 hours
* Replacement fluids will be bicarbonate-buffered with appropriate adjustments when citrate-anticoagulation is utilized
* All antibiotics will be dose adjusted for renal replacement therapy

Control group

Contemporary care via consideration of the Burn-Specific Sepsis Bundle adapted form the most recent Surviving Sepsis campaign recommendations and specifically modified to our patient population.

Group Type ACTIVE_COMPARATOR

Control Group

Intervention Type OTHER

Both groups will receive 'contemporary' care via consideration of the Burn-specific Sepsis Bundle adapted from the most recent Surviving Sepsis Campaign (SSC) (1) recommendations and specifically modified to our patient population

Interventions

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An FDA approved continuous renal replacement device

70ml/kg/hr for treatment group for 48 hours with the following requirements:

* double lumen dialysis catheter should be placed in the internal jugular or femoral vein
* Anticoagulation will be determined by prescribing physician
* Use of 1.4 m2 or larger biocompatible synthetic hollow-fiber dialysis membrane that is changed every 24 hours
* Blood flow rate will be set to ensure a filtration fraction of no more than 25%
* Monitoring for electrolytes (specifically K+, Mg, Ca, and phos) during HVHF must be performed at least every 6 hours
* Replacement fluids will be bicarbonate-buffered with appropriate adjustments when citrate-anticoagulation is utilized
* All antibiotics will be dose adjusted for renal replacement therapy

Intervention Type DEVICE

Control Group

Both groups will receive 'contemporary' care via consideration of the Burn-specific Sepsis Bundle adapted from the most recent Surviving Sepsis Campaign (SSC) (1) recommendations and specifically modified to our patient population

Intervention Type OTHER

Other Intervention Names

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High volume hemofiltration Standard of care

Eligibility Criteria

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Inclusion Criteria

* All adult patients admitted to the burn intensive care unit (ICU) with burns of any size
* Acute renal failure as previously defined by the Veterans Affairs/ National Institutes of Health (VA/NIH) Acute Renal Failure Trial Network study investigators(2)
* Patient is \> 48 hours post-burn and in Septic Shock
* Patients 18 or older
* Patient/legally authorized representative willing to provide consent

Exclusion Criteria

* Age \<18
* Non-thermal injury (exfoliating skin disorders or necrotizing fasciitis)
* Pre-admission diagnosis of end stage renal failure
* Patients already on renal replacement therapy for more than 24 hours
* Patient not expected to survive more than 24 hours after randomization.
* Pregnancy
* Prisoners
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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United States Army Institute of Surgical Research

FED

Sponsor Role collaborator

Tampa General Hospital

OTHER

Sponsor Role collaborator

Medstar Health Research Institute

OTHER

Sponsor Role collaborator

Loyola University

OTHER

Sponsor Role collaborator

University of Texas Southwestern Medical Center

OTHER

Sponsor Role collaborator

Valleywise Health

OTHER

Sponsor Role collaborator

University of Tennessee

OTHER

Sponsor Role collaborator

University of Kansas Medical Center

OTHER

Sponsor Role collaborator

Doctors Hospital-Joseph M Still Burn Center

UNKNOWN

Sponsor Role collaborator

American Burn Association

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kevin K Chung, MD

Role: STUDY_CHAIR

United States Army Institute of Surgical Research

Amy M Sprague, MD

Role: STUDY_DIRECTOR

Doctors Hospital

Locations

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Arizona Burn Center

Phoenix, Arizona, United States

Site Status

The Burn Center at Washington Hospital Center

Washington D.C., District of Columbia, United States

Site Status

Tampa General Hospital

Tampa, Florida, United States

Site Status

Doctors Hospital-Joseph M Still Burn Center

Augusta, Georgia, United States

Site Status

Loyola University Medical Center

Maywood, Illinois, United States

Site Status

University of Kansas Hospital

Kansas City, Kansas, United States

Site Status

Regional Medical Center at Memphis

Memphis, Tennessee, United States

Site Status

University of Texas Southwestern Medical Center-Burn Center Parkland Health

Dallas, Texas, United States

Site Status

US Army Institute of Surgical Research

Fort Sam Houston, Texas, United States

Site Status

Countries

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United States

References

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VA/NIH Acute Renal Failure Trial Network; Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008 Jul 3;359(1):7-20. doi: 10.1056/NEJMoa0802639. Epub 2008 May 20.

Reference Type BACKGROUND
PMID: 18492867 (View on PubMed)

Leblanc M, Thibeault Y, Querin S. Continuous haemofiltration and haemodiafiltration for acute renal failure in severely burned patients. Burns. 1997 Mar;23(2):160-5. doi: 10.1016/s0305-4179(96)00085-x.

Reference Type BACKGROUND
PMID: 9177886 (View on PubMed)

Greenhalgh DG, Saffle JR, Holmes JH 4th, Gamelli RL, Palmieri TL, Horton JW, Tompkins RG, Traber DL, Mozingo DW, Deitch EA, Goodwin CW, Herndon DN, Gallagher JJ, Sanford AP, Jeng JC, Ahrenholz DH, Neely AN, O'Mara MS, Wolf SE, Purdue GF, Garner WL, Yowler CJ, Latenser BA; American Burn Association Consensus Conference on Burn Sepsis and Infection Group. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007 Nov-Dec;28(6):776-90. doi: 10.1097/BCR.0b013e3181599bc9.

Reference Type BACKGROUND
PMID: 17925660 (View on PubMed)

Azevedo LC, Park M, Schettino GP. Novel potential therapies for septic shock. Shock. 2008 Oct;30 Suppl 1:60-6. doi: 10.1097/SHK.0b013e318181a425.

Reference Type BACKGROUND
PMID: 18704007 (View on PubMed)

Ratanarat R, Permpikul C. Roles of extracorporeal blood purification in sepsis. J Med Assoc Thai. 2007 May;90(5):1021-31.

Reference Type BACKGROUND
PMID: 17596062 (View on PubMed)

Chung KK, Lundy JB, Matson JR, Renz EM, White CE, King BT, Barillo DJ, Jones JA, Cancio LC, Blackbourne LH, Wolf SE. Continuous venovenous hemofiltration in severely burned patients with acute kidney injury: a cohort study. Crit Care. 2009;13(3):R62. doi: 10.1186/cc7801. Epub 2009 May 1.

Reference Type BACKGROUND
PMID: 19409089 (View on PubMed)

Piccinni P, Dan M, Barbacini S, Carraro R, Lieta E, Marafon S, Zamperetti N, Brendolan A, D'Intini V, Tetta C, Bellomo R, Ronco C. Early isovolaemic haemofiltration in oliguric patients with septic shock. Intensive Care Med. 2006 Jan;32(1):80-6. doi: 10.1007/s00134-005-2815-x. Epub 2005 Nov 18.

Reference Type BACKGROUND
PMID: 16328222 (View on PubMed)

Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000 Jul 1;356(9223):26-30. doi: 10.1016/S0140-6736(00)02430-2.

Reference Type BACKGROUND
PMID: 10892761 (View on PubMed)

Honore PM, Jamez J, Wauthier M, Lee PA, Dugernier T, Pirenne B, Hanique G, Matson JR. Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med. 2000 Nov;28(11):3581-7. doi: 10.1097/00003246-200011000-00001.

Reference Type BACKGROUND
PMID: 11098957 (View on PubMed)

Wagener G, Gubitosa G, Wang S, Borregaard N, Kim M, Lee HT. Urinary neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery. Am J Kidney Dis. 2008 Sep;52(3):425-33. doi: 10.1053/j.ajkd.2008.05.018. Epub 2008 Jul 23.

Reference Type BACKGROUND
PMID: 18649981 (View on PubMed)

Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, Malcangi V, Petrini F, Volta G, Bobbio Pallavicini FM, Rottoli F, Giunta F, Ronco C. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA. 2009 Jun 17;301(23):2445-52. doi: 10.1001/jama.2009.856.

Reference Type BACKGROUND
PMID: 19531784 (View on PubMed)

Gibran NS, Shipper E, Phuong J, Braverman M, Bixby P, Price MA, Bulger EM; NTRAP Burns & Reconstructive Surgery Panel Group. Developing a national trauma research action plan: Results from the Burn Research Gap Delphi Survey. J Trauma Acute Care Surg. 2022 Jan 1;92(1):201-212. doi: 10.1097/TA.0000000000003409.

Reference Type DERIVED
PMID: 34554139 (View on PubMed)

Chung KK, Coates EC, Smith DJ Jr, Karlnoski RA, Hickerson WL, Arnold-Ross AL, Mosier MJ, Halerz M, Sprague AM, Mullins RF, Caruso DM, Albrecht M, Arnoldo BD, Burris AM, Taylor SL, Wolf SE; Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) Investigators. High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: a multicenter randomized controlled trial. Crit Care. 2017 Nov 25;21(1):289. doi: 10.1186/s13054-017-1878-8.

Reference Type DERIVED
PMID: 29178943 (View on PubMed)

Other Identifiers

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W81XWH-09-2-0194

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

Combat Casualty Grant

Identifier Type: OTHER

Identifier Source: secondary_id

H-09-046

Identifier Type: -

Identifier Source: org_study_id

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