The aim of the study will be to evaluate the quality of the GFR estimate of the two estimation equations (CKD-EPI and Cockcroft's formula) against the measured clearance of creatinine, which can be performed routinely in intensive care. To determine the proportion of patients with ARC under ECMO VV or VA and determine changes in renal vascular resistance index as a function of GFR level in patients with pulsatile cardiac output.
Extracorporeal assistance is recommended for patients with a potentially reversible acute risk of life that does not respond to conventional treatments. Hypoxic refractory syndromes, such as acute respiratory distress syndrome, are referred to as veno-venous ECMO (for Extracorporeal Membrane Oxygenation) (ECMO VV), whereas terminal cardiac dysfunctions require veno-arterial ECMO (VA ECMO). recovery of function (cardiotropic intoxication), or in the most severe cases, pending transplantation or long-term assistance. This is a qualified pilot study, as it is the first one interested in evaluating the quality of the GFR estimate of the two estimation equations (CKD-EPI and Cockcroft formula) by relative to the measured clearance of creatinine, a method that can be performed routinely in intensive care, for resuscitation patients under veno-arterial or veno-venous ECMO.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
100
Collection of urine over 3 hours for creatinine clearance measurement, with serum creatinine in parallel with urine collection to calculate measured creatinine clearance and estimate glomerular filtration rate Evaluation of the renal vascular resistance index in Doppler ultrasound by a resuscitator trained in the technique at the time of inclusion. Collection of demographic, clinical and biological data for inclusion of the patient such as weight, age, sex, arterial lactatemia, arterial pH, volume status, use of diuretics, use of vasopressors, use of nephrotoxic drugs ...
University Hospital Toulouse
Toulouse, France
RECRUITINGCompare the clearance of creatinine in urine with GFR
Measured clearance of creatinine in urine (collected over 3 hours during haemodynamic stabilization of the patient) that will be compared to the Glomerular Filtration Rate(GFR) (estimated according to the Cockcroft and CKD-EPI formulas).
Time frame: 1 hour
Number of patients in ECMO with augmented renal clearance (ARC)
In intensive care, some patients also have an often unrecognized increase in creatinine clearance. This entity named "augmented renal clearance" or ARC is defined by creatinine clearance\> 150 mL / min / 1.73 m² for a woman and\> 160 mL / min / 1.73 m² for a man. It is causing a decrease in the plasma concentration of certain drugs, especially antibiotics, which can lead to a therapeutic failure. A poor evaluation of the renal function in the intensive care unit can lead to overdoses or to underdosages of the drugs, by phenomena of hypofiltration or on the contrary of renal hyperfiltration.
Time frame: 1 hour
Index of renal vascular resistance
index of renal vascular resistance obtained by Doppler ultrasound by a resuscitator trained in the technique at the time of inclusion.
Time frame: 18 months
Differences in the variable GFR between patients with glomerular hypofiltration
Differences in the variable GFR between patients with glomerular hypofiltration, normofiltration and hyperfiltrating patients with ClCr \<60 mL / min / 1.73 m², and for normofiltration patients and hyperfiltrate patients it means CrCl\> 150 mL / min / 1.73 m² for a woman and CrCl\> 160 mL / min / 1.73 m² for a ma).
Time frame: 18 months
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