Protocolized Reduction of Non-resuscitation Fluids vs Usual Care in Septic Shock Feasibility Trial

NCT ID: NCT05249088

Last Updated: 2023-12-11

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

COMPLETED

Clinical Phase

NA

Total Enrollment

98 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-01

Study Completion Date

2023-03-27

Brief Summary

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The objectives of this feasibility trial are to assess the efficacy and feasibility of methods and procedures of a protocol purposed to compare a reduction of administration of non-resuscitation fluids to usual care in patients with septic shock.

Detailed Description

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Conditions

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Shock, Septic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
The clinical team caring for participants will not be blinded due to nature of the intervention. The participants, their family and health personnel responsible for outcome assessment at follow-up will be blinded to the allocation of the intervention. The steering group, author group, trial statistician, outcome assessors, prognosticators, statisticians, and the trial coordinating team will be blinded to group allocation.

Study Groups

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Protocolised reduction of non-resuscitation fluids

Participants receive non-resuscitation fluids according to a pre-defined protocol starting within two hours of randomization. The intervention is continued for the duration of the ICU admission up to a maximum of 90 days.

Group Type EXPERIMENTAL

Protocolised reduction of non-resuscitation fluids

Intervention Type OTHER

* Maintenance fluids are discontinued in participants with positive cumulative fluid balance who are not dehydrated
* Intravenous fluid and enteral water are given as needed to correct electrolyte disturbances
* Enteral nutrition with energy density of at least 2 kcal/ml is administered according to local practice
* Starting 72 hours after inclusion, glucose at a concentration of at least 20% and a maximal dose of 1g/kg/day may be used as nutrition if enteral feeding is not tolerated. Glucose at this dose or lower may be started earlier in patients with insulin dependent diabetes if enteral feeding is not tolerated and local protocol mandates this
* Parenteral nutrition is administered according to local protocol
* Intravenous medications are concentrated according to a predefined protocol
* Patients with neutral or negative cumulative fluid balance receive maintenance and other fluids such that total dose of fluids covers the daily need of water (about 1ml/kg/h)

Usual Care

Participants receive non-resuscitation fluids according to local routines.

Group Type OTHER

Usual care

Intervention Type OTHER

Participants receive non-resuscitation fluids according to local routines, with the following stipulations:

* Maintenance fluids (crystalloids and/or glucose and/or enteral water) are given at a dose of 1 ml/kg/h unless local protocol states otherwise
* Glucose is used at maximal concentration of 10% unless local protocol states otherwise.
* Medications are concentrated according to local protocol

Interventions

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Protocolised reduction of non-resuscitation fluids

* Maintenance fluids are discontinued in participants with positive cumulative fluid balance who are not dehydrated
* Intravenous fluid and enteral water are given as needed to correct electrolyte disturbances
* Enteral nutrition with energy density of at least 2 kcal/ml is administered according to local practice
* Starting 72 hours after inclusion, glucose at a concentration of at least 20% and a maximal dose of 1g/kg/day may be used as nutrition if enteral feeding is not tolerated. Glucose at this dose or lower may be started earlier in patients with insulin dependent diabetes if enteral feeding is not tolerated and local protocol mandates this
* Parenteral nutrition is administered according to local protocol
* Intravenous medications are concentrated according to a predefined protocol
* Patients with neutral or negative cumulative fluid balance receive maintenance and other fluids such that total dose of fluids covers the daily need of water (about 1ml/kg/h)

Intervention Type OTHER

Usual care

Participants receive non-resuscitation fluids according to local routines, with the following stipulations:

* Maintenance fluids (crystalloids and/or glucose and/or enteral water) are given at a dose of 1 ml/kg/h unless local protocol states otherwise
* Glucose is used at maximal concentration of 10% unless local protocol states otherwise.
* Medications are concentrated according to local protocol

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult (≥ 18 years of age)
* Septic shock according to the Sepsis 3 criteria: suspected or confirmed infection AND infusion of vasopressor/inotrope to maintain mean arterial pressure of 65 mmHg or above despite adequate fluid resuscitation AND lactate of 2 mmol/L or above at any time following ICU admission when there was a simultaneous need for vasopressor/inotrope.
* Inclusion within 12 hours after ICU admission.

Exclusion Criteria

* Confirmed or suspected pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Region Skane

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Peter Bentzer, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Region Skåne

Locations

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Sahlgrenska University Hospital

Gothenburg, , Sweden

Site Status

Halmstad Hospital

Halmstad, , Sweden

Site Status

Helsingborg Hospital

Helsingborg, , Sweden

Site Status

Kristianstad Hospital

Kristianstad, , Sweden

Site Status

Skåne University Hospital, Lund

Lund, , Sweden

Site Status

Skåne University Hospital, Malmö

Malmo, , Sweden

Site Status

Östersund Hospital

Östersund, , Sweden

Site Status

Uppsala University Hospital

Uppsala, , Sweden

Site Status

Countries

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Sweden

References

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Linden A, Fisher J, Lilja G, Olsen MH, Sjovall F, Jungner M, Spangfors M, Samuelsson L, Oras J, Linder A, Unden J, Kander T, Lipcsey M, Nielsen N, Jakobsen JC, Bentzer P. Protocolised reduction of non-resuscitation fluids versus usual care in patients with septic shock (REDUSE): a protocol for a multicentre feasibility trial. BMJ Open. 2023 Feb 28;13(2):e065392. doi: 10.1136/bmjopen-2022-065392.

Reference Type BACKGROUND
PMID: 36854601 (View on PubMed)

Linden A, Spangfors M, Olsen MH, Fisher J, Lilja G, Sjovall F, Jungner M, Lengquist M, Kander T, Samuelsson L, Johansson J, Palmnas E, Unden J, Oras J, Cronhjort M, Chew M, Linder A, Lipcsey M, Nielsen N, Jakobsen JC, Bentzer P; REDUSE Trial Group. Protocolized reduction of non-resuscitation fluids versus usual care in septic shock patients (REDUSE): a randomized multicentre feasibility trial. Crit Care. 2024 May 17;28(1):166. doi: 10.1186/s13054-024-04952-w.

Reference Type DERIVED
PMID: 38760833 (View on PubMed)

Related Links

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https://zenodo.org/records/7392132

Markus Harboe Olsen, et al. Protocolised Reduction of Non-resuscitation Fluids Versus Usual Care in Septic Shock Patients (REDUSE) - a Statistical Analysis Plan for a Multicentre Feasibility Trial. 3.00, Zenodo, Dec. 2022, doi:10.5281/zenodo.7392132.

Other Identifiers

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REDUSE feasibility trial

Identifier Type: -

Identifier Source: org_study_id