Natriuresis-guided Depletion After Cardiac Surgery (EASY-CS)

Centre Hospitalier Universitaire, Amiens

Status: Enrolling

Conditions: Cardiac Surgery; Fluid Over-load; Congestion, Venous; Sodium Depletion; Diuresis

Treatments: Drug: Furosemide intravenous titration based on natriuresis; Drug: Furosemide intravenous titration based on clinical examination

Study type: Interventional

Funder types: Other

Identifiers

NCT07077772

PI2025_843_0080

Details and patient eligibility

About

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.

Enrollment: 102 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 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 criteria

• 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)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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102 participants in 2 patient groups

Natriuresis-Guided Arm

Experimental group

Description:

Furosemide IV, 20 mg starting dose, titrated every 6 hours based on urinary sodium measured by the LAQUATWIN device.

Treatment:

Drug: Furosemide intravenous titration based on natriuresis

Control

Active Comparator group

Description:

Furosemide IV, 20 mg starting dose, titrated every 6 hours based on clinical evaluation

Treatment:

Drug: Furosemide intravenous titration based on clinical examination