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dc.contributor.authorVaara, Suvi T-
dc.contributor.authorOstermann, Marlies-
dc.contributor.authorBitker, Laurent-
dc.contributor.authorSchneider, Antoine-
dc.contributor.authorPoli, Elettra-
dc.contributor.authorHoste, Eric-
dc.contributor.authorFierens, Jan-
dc.contributor.authorJoannidis, Michael-
dc.contributor.authorZarbock, Alexander-
dc.contributor.authorvan Haren, Frank-
dc.contributor.authorProwle, John-
dc.contributor.authorSelander, Tuomas-
dc.contributor.authorBäcklund, Minna-
dc.contributor.authorPettilä, Ville-
dc.contributor.authorBellomo, Rinaldo-
dc.identifier.citationIntensive Care Medicine 2021; 47(6): 665-673en
dc.description.abstractWe compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation. This multicenter feasibility trial randomized 100 AKI patients 1:1 in seven ICUs in Europe and Australia. Restrictive fluid management included targeting negative or neutral daily fluid balance by minimizing fluid input and/or enhancing urine output with diuretics administered at the discretion of the clinician. Fluid boluses were administered as clinically indicated. The primary endpoint was cumulative fluid balance 72 h from randomization. Mean (SD) cumulative fluid balance at 72 h from randomization was - 1080 mL (2003 mL) in the restrictive fluid management arm and 61 mL (3131 mL) in the usual care arm, mean difference (95% CI) - 1148 mL (- 2200 to - 96) mL, P = 0.033. Median [IQR] duration of AKI was 2 [1-3] and 3 [2-7] days, respectively (median difference - 1.0 [- 3.0 to 0.0], P = 0.071). Altogether, 6 out of 46 (13%) patients in the restrictive fluid management arm and 15 out of 50 (30%) in the usual care arm received renal replacement therapy (RR 0.42; 95% CI 0.16-0.91), P = 0.043. Cumulative fluid balance at 24 h and 7 days was lower in the restrictive fluid management arm. The dose of diuretics was not different between the groups. Adverse events occurred more frequently in the usual care arm. In critically ill patients with AKI, a restrictive fluid management regimen resulted in lower cumulative fluid balance and less adverse events compared to usual care. Larger trials of this intervention are justified.en
dc.subjectAcute kidney injuryen
dc.subjectCritically illen
dc.subjectFluid balanceen
dc.subjectRestrictive fluid managementen
dc.titleRestrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial.en
dc.typeJournal Articleen
dc.identifier.journaltitleIntensive Care Medicineen
dc.identifier.affiliationCREATIS CNRS UMR5220 INSERM U1044 INSA-Lyon, Université de Lyon, Lyon, Franceen
dc.identifier.affiliationCentre for Integrated Critical Care, School of Medicine, The University of Melbourne, Melbourne, Australiaen
dc.identifier.affiliationAdult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerlanden
dc.identifier.affiliationCritical Care and Preoperative Medicine Research Group, Centre for Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UKen
dc.identifier.affiliationDepartment of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UKen
dc.identifier.affiliationIntensive Careen
dc.identifier.affiliationDivision of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finlanden
dc.identifier.affiliationIntensive Care Unit M1, Meilahti Hospital, Box 340, 00290, Helsinki, Finlanden
dc.identifier.affiliationAustralian National University Medical School, Canberra, Australiaen
dc.identifier.affiliationIntensive Care Unit, Canberra Hospital, Canberra, Australiaen
dc.identifier.affiliationIntensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgiumen
dc.identifier.affiliationDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austriaen
dc.identifier.affiliationDepartment of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germanyen
dc.identifier.affiliationScience Service Center, Kuopio University Hospital, Kuopio, Finlanden
dc.identifier.affiliationDivision of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finlanden
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