Grant: Project Grant

Life support measures provided to critically ill patients in an intensive care unit (ICU) include the infusion of fluids directly into a vein (intravenously - IV). IV fluids support the circulation when a patient is unable to drink, and provide a means of delivering medications, and many liters may be given over the first few days. However the accumulation of salt and water in the tissues can contribute to impaired organ function. Out work and that of others suggests that fluid retention results in an increased risk of death and prolonged ICU stay, raising the possibility that actively intervening to remove excess fluid by increasing urine output may improve patient outcomes. Since the administration of fluids is called resuscitation, we have termed this approach "deresuscitation". We know from our observational study that ICU physicians use such an approach in some, but not all patients suffering from fluid overload. But we do not know how best to deresuscitate patients, or even whether it is possible in most patients. Moreover we do not know the risks and benefits of such an approach. Consequently the RADAR (Role of Active Deresuscitation After Resuscitation) pilot trial will be conducted to determine how best to design and run a larger study to evaluate the risks and benefits to patients. This pilot study will: 1.) Determine whether a deresuscitation protocol is more effective than usual care in hastening fluid removal 2.) Determine whether clinicians will be willing to enroll patients and to keep them in the arm to which they have been randomized 3). Estimate the number of eligible patients who can be recruited to determine the size and duration of a definitive trial 4). Provide insight into how to refine the deresuscitation protocol so that it can be studied in an international trial. The RADAR pilot trial will recruit 180 critically ill patients in 10 Canadian ICUs, and is being coordinated with a similar initiative in the United Kingdom.