When and how much fluid to remove in critically ill patients

Timing and Dose of Fluid Deresuscitation in Critically Ill Patients: a Prospective Observational Multicenter Study

This study will test which patients, timing, and rates of fluid removal (diuretics or ultrafiltration) work best for critically ill adults in the ICU who need deresuscitation.

Quick facts

• Study type: Observational
• Enrollment: 150 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) (Academic / other)
• Locations: 2 sites (Amsterdam and 1 other locations)
• Trial ID: NCT07275658 on ClinicalTrials.gov

What this trial studies

This is a multicenter, prospective observational cohort of adult ICU patients who have a treating-physician–determined indication for deresuscitation. Clinical data, point-of-care ultrasound measures, and laboratory and metabolic profiles will be collected during the first attempt at deresuscitation. The primary outcome is successful deresuscitation, defined as achieving a negative fluid balance within 24 hours without hemodynamic consequences, with secondary work on timing, rate (dose) and subgroup differences (sepsis, ARDS, cardiac patients). Analyses will explore predictors of diuretic and ultrafiltration response, optimal individualized deresuscitation rates, and associations with complications such as electrolyte/acid–base disturbances, hemodynamic instability, atrial fibrillation, and delirium.

Who should consider this trial

Good fit: Adult ICU patients at a participating site who have a first clinical indication for deresuscitation using diuretics or ultrafiltration as decided by the treating physician are ideal candidates.

Not a fit: Patients under 18, those with major cardiac shunts or moderate-to-severe aortic regurgitation, morbid obesity (BMI >40), pre-existing lung disease preventing reliable ultrasound, those on ECMO or transferred from another ICU, moribund patients, or those who opt out are unlikely to benefit from participation.

Why it matters

Potential benefit: If successful, the findings could help clinicians personalize when and how fast to remove fluid to make deresuscitation safer and more effective, potentially reducing complications.

How similar studies have performed: Previous research supports conservative fluid management and diuresis in critical illness, but prospectively defining determinants and individualizing timing and dose using integrated ultrasound and metabolic profiling is relatively novel and not yet proven.

Eligibility criteria

Inclusion Criteria:

* Admission to one of the participating ICUs;
* Clinical indication for deresuscitation using diuretics or ultrafiltration as set by the treating physician; first attempt during the ICU stay.

Exclusion Criteria:

* Age below 18 years old;
* Major cardiac shunts;
* Moderate to severe aortic regurgitation;
* Morbid Obesisty (BMI \>40);
* POCUS impossible or unreliable (i.e. pre-existing interstitial lung disease);
* PLR or modified form of PLR impossible (i.e. ECMO);
* Transfer from another ICU;
* Previous inclusion in this study;
* Patients who are moribund or facing the end of life;
* Opt out.

Where this trial is running

Amsterdam and 1 other locations

• Olvg — Amsterdam, Netherlands (Recruiting)
• Amsterdam UMC — Amsterdam, Netherlands (Recruiting)

Study contacts

• Study coordinator: Krijna Opschoor, MD

Conditions Fluid Overload; Critical Care, Intensive Care; Deresuscitation; ultrasound, RRT, furosemide