Controlled Fluid Resuscitation in Sepsis

Shanghai Jiao Tong University

Status: Unknown

Conditions: Sepsis

Treatments: Other: Ruijin Strategy; Other: Early Goal Directed Therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT03214913

Sepsis Fluid 1

Details and patient eligibility

About

To evaluate two different strategy of fluid resuscitation in sepsis patients

Full description

Early goal-directed fluid therapy (EGDT) had been regarded as an important fluid therapy strategy in early sepsis or septic shock patients. In recent years, several randomized control studies showed the EGDT therapy cannot make a better outcome in sepsis patients compared to the standard therapy. A strategy of controlled fluid resuscitation had showed good outcome in critical illness such as severe acute pancreatitis, major trauma. But many aspects of the so-called controlled fluid resuscitation remained controversial. In a previous study on severe acute pancreatitis, we described a bundle of controlled fluid resuscitation which had showed an ideal result with higher survival rate. So, we are going to use the bundle on sepsis patients, and to see if it can bring a better out come in sepsis patients compared to the EGDT strategy. This study aims to determine a better strategy of fluid resuscitation in sepsis patients

Enrollment: 550 estimated patients

Sex: All

Ages: 8 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 1.sepsis patients in accordance with the Sepsis 3.0 definition(SOFA increase ≥2 compared to the baseline，due to infection )
• 2.the first blood lactate in our hospital is ≥ 4mmol/L or MAP<90mmHg after 20ml/kg fluid bolus
• 3.the shock is diagnosed within 24hrs after onset

Exclusion criteria

• • 1.<18 years old
• 2.Pregnancy
• 3 with co-morbidity such as AE-COPD, stroke, seizure, lung edema, acute coronary syndrome
• 4 with contra-indication of CVC(central venous catheter) placement
• 5 trauma or major burn
• 6 poisoning
• 7 any cancer receiving chemotherapy
• 8.immunosuppression (for organ transplantation or disease of immune system)
• 9.acute pancreatitis
• 10.relapse sepsis

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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550 participants in 2 patient groups

EGDT Group

Other group

Description:

Early Goal Directed Therapy ：30ml/kg in the first bolus to have a CVP（central venous pressure） 8-12 mmHg and MAP（mean artery pressure ） 65-85 mm Hg,and urine output ≥0.5 ml/kg/h, ScvO2 ≤70%；If not, use noradrenaline，red blood cell transfusion if necessary.

Treatment:

Other: Early Goal Directed Therapy

Ruijin Group

Other group

Description:

Ruijin Strategy therapy：10\~5ml/kg/h，crystalloid vs colloid 2:1 resuscitation;using noradrenaline at the same time;red blood cell transfusion if necessary. target： fulfillment of two or more of four criteria:1. HR（heart rate） \<120 beats/min, 2.MAP 65-85 mm Hg, 3. urine output ≥1 ml/kg /h 4. HCT（hematocrit） 25%\~35%.

Treatment:

Other: Ruijin Strategy