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Prospective randomized double blind phase IV trial studying the efficacy and safety of the tonicity of two different perioperative maintenance solutions: an isotonic solution containing NaCl 0.9 in glucose 5% with an added 40 mmol/L of potassium or a commercially available premixed solution (Glucion 5%) containing a.o. 54 mmol/L of sodium and 26 mmol/L of potassium. Both solutions are administered at 27 mL/kg of ideal body weight, as recommended by current guidelines (NICE 174) and both solutions are widely used in daily clinical practice. The primary hypothesis is that isotonic maintenance solutions lead to more fluid retention than hypotonic fluids. Metabolism of both solutions is assessed by sequential analysis of urine and serum and clinical parameters.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NaCl 0.9% in Glucose 5% + 40mmol/L Potassium | Active Comparator |
| |
| Glucion 5% | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NaCl 0.9% in Glucose 5% + 40mmol/L Potassium | Drug | Study fluid used at maintenance rate of 27 mmol per kg of body weight per day from beginning of surgery until end of study. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Fluid balance | Difference between all fluid intake and output | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) |
| Measure | Description | Time Frame |
|---|---|---|
| Resuscitation Fluids | The cumulative amount of additional (resuscitation) fluids during the study period | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) |
| Vasopressor Use |
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Inclusion Criteria:
Exclusion Criteria:
Additional pre-defined exclusion after initial inclusion
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital, Antwerp | Edegem | 2650 | Belgium |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 12044376 | Background | Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002 May 25;359(9320):1812-8. doi: 10.1016/S0140-6736(02)08711-1. | |
| 26422725 | Background | Moritz ML, Ayus JC. Maintenance Intravenous Fluids in Acutely Ill Patients. N Engl J Med. 2015 Oct;373(14):1350-60. doi: 10.1056/NEJMra1412877. No abstract available. |
| Label | URL |
|---|---|
| NICE guideline on Intravenous Fluid Therapy in Adults in Hospital | View source |
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Anonymized data available on reasonable request
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| ID | Term |
|---|---|
| D013896 | Thoracic Diseases |
| D014883 | Water-Electrolyte Imbalance |
| D004487 | Edema |
| ID | Term |
|---|---|
| D012140 | Respiratory Tract Diseases |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D005947 | Glucose |
| D011188 | Potassium |
| ID | Term |
|---|---|
| D006601 | Hexoses |
| D009005 | Monosaccharides |
| D000073893 | Sugars |
| D002241 | Carbohydrates |
| D008672 |
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Study fluids blinded using opaque bags
| Glucion 5% | Drug | Study fluid used at maintenance rate of 27 mmol per kg of body weight per day from beginning of surgery until end of study. |
|
The cumulative amount of vasopressors during the study period |
| From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) |
| Physiological Mechanisms: Aldosterone level | Change from baseline aldosterone level at start of surgery | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Physiological Mechanisms: Fractional Excretion of Sodium | Change from baseline FeNa at start of surgery | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Electrolyte Homeostasis and Disorders: Sodium | Mean sodium level and change from baseline. Occurrence of hypo and hypernatremia. | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Electrolyte Homeostasis and Disorders: Potassium | Mean potassium level and change from baseline. Occurrence of hypo and hyperpotassemia. | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Electrolyte Homeostasis and Disorders: Chloride | Mean chloride level and change from baseline. Occurrence of hypo and hyperchloremia. | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Electrolyte Homeostasis and Disorders: Strong Ion Difference | Mean SID level and change from baseline. | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Electrolyte Homeostasis and Disorders: Phosphate | Mean phosphate level and change from baseline. Occurrence of hypo and hyperphosphatemia. | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Electrolyte Homeostasis and Disorders: Calcium | Mean calcium level and change from baseline. Occurrence of hypo and hypercalcemia. | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Clinical Endpoints: paO2/FiO2 | Mean postoperative paO2/FiO2 | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery) - Assessments at fixed time points. |
| Clinical Endpoints: occurrence of de novo atrial fibrillation | occurrence of de novo atrial fibrillation (Y/N) | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery). Continuous assessment. |
| Clinical Endpoints: occurrence of acute kidney injury (AKI) | AKI according to RIFLE-score creatinine and urine R-I-F) | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery). Continuous assessment. |
| Sodium balance | Sodium balance (total in vs out) at end of study, assessed by urine collection. | From start of surgery until end of study, defined as one of the following (1) discharge from ICU (2) 8AM on third postoperative day (maximum: up to 72h after start of surgery). |
| GIFTASUP guidelines | View source |
| D013568 | Pathological Conditions, Signs and Symptoms |
| Metals, Alkali |
| D004602 | Elements |
| D007287 | Inorganic Chemicals |
| D019565 | Metals, Light |
| D008670 | Metals |