Fluid Resuscitation in Burn Patients (CARE)
Clearance of Acetate During Fluid Resuscitation of Critically Ill Burn Patients: The CARE Trial.
Balanced solutions with low chloride concentration could represent an alternative to high chloride concentration solutions. Such balanced solutions contain other acid as buffers (i.e. acetate and/or gluconate). However, acetate has been associated with alteration of cardiac function when used as buffer in dialysate when high acetate concentrations are used and could promote the development of metabolic acidosis if it accumulates. Therefore, the safety of such solutions remains poorly explored. Because critically ill patients receive large amount of fluid during the early phase of resuscitation, large amount of acetate are to be administrated if such solutions are used. While acetate-containing solutions have been suggested to be safe in this setting, studies are still lacking regarding clearance and accumulation in critically ill patients.
It is expected to include 28 patients, the objective to analyze the data of 20 patients.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Locations
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-
-
Paris, France, 75010
- Departement of Anesthesiology, Critical Care and Burn Unit; Saint-Louis hospital
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients over 18 years
- TBSA>30%
- Admission to an intensive care unit within 12 hours after burn injury
- Signed informed consent to Patient / Parent / ( Inclusion in Emergency and Consent is Collected)
- social Insurance cover
Exclusion Criteria:
- Decline to participate
- pregnancy
- Metabolic alkalosis (excess of base> 5mmol / L)
- legal obstacle to participate
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Plasmalyte®
Plasmalyte® is a balanced solution containing a low chloride concentration (i.e.
98 mmol/L), it also contains acetate (27 mmol/L) and gluconate (23 mmol/L) as buffer solutions.
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Parenteral administration of Plasmalyte initiated immediately after inclusion at a dosage of 4 ml / kg per percentage area of skin burned for the first 24 hours after burn injury and adjusted based on hemodynamic monitoring. Each patient will receive this solution up to 5 days.
Other Names:
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Experimental: Ringer Lactate®
Ringer Lactate® is a balanced solution containing a low chloride concentration (i.e.
111mmol/L), it also contains lactate (29 mmol/L) as buffer solutions.
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Parenteral administration of Ringer lactate initiated immediately after inclusion at a dosage of 4 ml / kg per percentage area of skin burned for the first 24 hours after burn injury and adjusted based on hemodynamic monitoring. Each patient will receive this solution up to 5 days.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
The main endpoint is to compare the base deficit in patients receiving Plasmalyte® or Ringer lactate after 24 hours of admission.
Time Frame: after 24 hours of admission.
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Arterial blood gas analysis
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after 24 hours of admission.
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Acetate, gluconate and lactate clearance respectively in patients receiving Plasmalyte® or Ringer lactate.
Time Frame: Every 6 hours for 48 hours, then every 12 hours for acid-base status during 5 days.
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Arterial blood gas analysis
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Every 6 hours for 48 hours, then every 12 hours for acid-base status during 5 days.
|
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acid-base status and strong ion difference after 24 hours of Plasmalyte® or Ringer lactate infusion
Time Frame: Every 6 hours for 48 hours, then every 12 hours for acid-base status during 5 days.
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Arterial blood gas analysis
|
Every 6 hours for 48 hours, then every 12 hours for acid-base status during 5 days.
|
|
Occurrence of cardiac dysfunction, defined as altered left ventricular ejection fraction(<50%)
Time Frame: Every day during 5 days
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Trans-thoracic or trans-esophageal ultrasound
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Every day during 5 days
|
|
Incidence of AKI (according to the KDIGO definition)
Time Frame: Every day during 5 days
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urine output and serum creatinine
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Every day during 5 days
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Sequential Organ Failure Assessment score
Time Frame: During the first 5 days of intensive care unit stay
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SOFA score calculation
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During the first 5 days of intensive care unit stay
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mortality at day 28
Time Frame: At 28 day after admission
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Mortality will be collected
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At 28 day after admission
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Matthieu Legrand, MD, PhD, Departement of Anesthesiology, Critical Care and Burn Unit; Saint-Louis hospital, 1 Avenue Claude Vellefaux, 75010, Paris & University Paris Diderot
Publications and helpful links
General Publications
- Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, Kellum JA. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg. 2012 May;255(5):821-9. doi: 10.1097/SLA.0b013e31825074f5.
- Hahn RG. Should anaesthetists stop infusing isotonic saline? Br J Anaesth. 2014 Jan;112(1):4-6. doi: 10.1093/bja/aet292. No abstract available.
- Zhou F, Peng ZY, Bishop JV, Cove ME, Singbartl K, Kellum JA. Effects of fluid resuscitation with 0.9% saline versus a balanced electrolyte solution on acute kidney injury in a rat model of sepsis*. Crit Care Med. 2014 Apr;42(4):e270-8. doi: 10.1097/CCM.0000000000000145.
- Davies PG, Venkatesh B, Morgan TJ, Presneill JJ, Kruger PS, Thomas BJ, Roberts MS, Mundy J. Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution. Crit Care. 2011;15(1):R21. doi: 10.1186/cc9966. Epub 2011 Jan 14.
- Morgan TJ, Power G, Venkatesh B, Jones MA. Acid-base effects of a bicarbonate-balanced priming fluid during cardiopulmonary bypass: comparison with Plasma-Lyte 148. A randomised single-blinded study. Anaesth Intensive Care. 2008 Nov;36(6):822-9. doi: 10.1177/0310057X0803600611. Erratum In: Anaesth Intensive Care. 2012 Jul;40(4):719.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- P160502
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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