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CS-AKI occurring in 20% to 70% of cases depending of the type of cardiac surgery. The systemic inflammatory response is often observed and associated with increased risk of AKI. Cardiopulmonary bypass (CPB) induces a complex inflammatory response that has a multifactorial pathogenesis. The inflammatory response is triggered by exposure of the blood to artificial surfaces during extracorporeal circulation, ischemia/reperfusion injuries, translocation of gram-negative bacteria from the intestinal tract, small amounts of LPS in IV solutions. SIRS during CPB with high levels of inflammatory mediators, active complement proteins and LPS provoke endothelial dysfunction- retraction of endothelial cells with increasing vascular permeability and thrombogenic activity, also inflammatory mediators activate leukocytes and they enhance vascular permeability by affecting endothelial cells and vascular basement membrane. The systemic inflammation and endothelial dysfunction are the basis for multiple organ dysfunction syndrome. Vascular integrity damage during cardiac surgery entail redistribution of fluids with interstitial fluid accumulation and require accurate volume control (pertinent removal of "CPB priming volume"), especially in patients with CKD (low GFR) with high risks of AKI.
Specific details of Treatment/Intervention: (prescription and/or therapy, devices, equipment, solutions, product to be used in conducting study:
To apply Prismaflex system with oXiris membrane after cardiopulmonary bypass in SCUF modality for CPB priming volume elimination.
Duration of procedure: 6 hours Blood flow:150-200 ml/min Anticoagulation: no additional heparinization.
According to the features of oXiris membrane:
The goal of the research:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| patients undergoing CRRT with oXiris membrane | Experimental | Elective cardiac surgery patients undergoing CPB we will range in 2 groups: I- with Prismaflex set oXiris (SCUF) after CPB, II- standard protocol. Indications for CRRT (SCUF) with oXiris after ICU admission: 1. Signs of pulmonary edema after cardiac surgery, verified with X-ray control. Or high risk of pulmonary edema after cardiac surgery:
In this arm the treatment of fluid overload will be provided via SCUF with oxiris membrane |
|
| standard protocol | No Intervention | Elective cardiac surgery patients undergoing CPB we will range in 2 groups: I- with Prismaflex set oXiris (SCUF) after CPB, II- standard protocol. Indications for CRRT (SCUF) with oXiris after ICU admission: 1. Signs of pulmonary edema after cardiac surgery, verified with X-ray control. Or high risk of pulmonary edema after cardiac surgery:
In this arm the management of fluid overload will be provided via diuretics or IHD (in condition diuretics treatment resistance) |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| oXiris membrane | Device | Open heart surgery patients in early postoperative period with clinical signs of fluid overload undergoing CRRT |
|
| Measure | Description | Time Frame |
|---|---|---|
| Patient volume status assessment in perioperative period | To compare volume status in two arms based on CVP mmH2O and PAWP mmHg measurements | in 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| survival after cardiac surgery | to compare in arms with oxiris treatment and standard protocol amount of survived patients | in 90 day |
| 'ICU and hospital length of stay after cardiac surgery. | to compare in arms with oxiris treatment and standard protocol the amount of days spent in ICU wards and in hospital |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yury Polushin, PhD | Contact | +7 (812) 338-66-49 | polushin1@gmail.com | |
| Dmitry Sokolov, MD | Contact | +7(911)7193333 | sokolovdv82@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Yury Polushin, PhD | Pavlov First St. Petersburg State Medical University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Pavlov First St. Petersburg State Medical University | Recruiting | Saint Petersburg | Russsia | 197022 | Russia |
de-identified individual participant data for all primary and secondary outcome measures will be made available
data will be available within 1 year of study completion
data access request will be reviewed by an external independent review panel.
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| ID | Term |
|---|---|
| D058186 | Acute Kidney Injury |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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| in 28 days |
| D005261 |
| Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |