MICROSHOCK - RENAL
Research type
Research Study
Full title
Macro and microcirculatory haemodynamic responses to shock in the renal and systemic circulations; a prospective longitudinal observational study
IRAS ID
246076
Contact name
Sam Hutchings
Contact email
Sponsor organisation
King's College Hospital NHS Foundation Trust
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Severe sepsis is a life-threatening condition caused by overwhelming infection. By definition these patents exhibit dysfunction of key organs, with the kidney frequently affected, sometimes to the point of failure. \n\nSevere sepsis causes profound effects on blood flow to the organs of the body with effects on both the overall circulating blood volume, through direct loss of fluid, and also the tone of the blood vessels which can cause a loss of flow and pressure. Furthermore, recent increases in our knowledge of the dynamics of blood flow in very small blood vessels, termed the microcirculation, has led to the realisation that disturbances in flow through these vessels is a vital factor in determining outcome from septic shock. Although harder to measure than flow in large blood vessels, recently introduced hand-held microscopes have enabled such assessments to take place at the bedside. The kidney is one of the most vulnerable organs to changes in blood flow and volume. Traditional teaching has focused on the maintenance of overall circulating blood volume and tone in an attempt to ameliorate these effects but this almost certainly oversimplifies what is a complex situation. Furthermore, the administration of large volumes of fluid during resuscitation in an attempt to protect the kidney has been shown to cause harm. What is required is more intelligent targeting of resuscitation at both the small and large blood vessels of the kidney and to do this we require more evidence as to how these blood vessels respond to septic shock and fluid administration. Using novel, minimally invasive, monitoring the proposed study will examine both small and large blood vessels in the kidney, the heart and the general circulation in patients with severe sepsis. We will use this data to shape future treatments with the aim of improving outcomes for patients. [COVID-19 amendment 20/04/2020] late December 2019, in Wuhan, Hubei, China, a new respiratory syndrome emerged with clinical signs resembling viral pneumonia and person-to-person transmission. It has been defined as a pandemic by the World Health Organisation on 11th March 2020 with over 100,000 cases globally. Although most clinical presentations are mild a significant proportion require hospitalisation and support within intensive care. Importantly, severe AKI, requiring RRT occurs in a significant proportion of critically ill patients. Worldwide the number of COVID-19 patients with AKI has been reported between 0.5% and 23%, with variability likely accounted for by variation in case testing and AKI definition used. Only one published paper considers critical illness syndrome requiring RRT and reports this as 19%. Analysis of the first 775 COVID-19 patients in UK reported 17% requiring RRT. In the context of local service provision 38% of the first 85 patients admitted to critical care within King’s College Hospital required RRT within the first 5 days. The aetiology of this AKI is unclear and the contribution of perfusion deficits to this condition is of particular relevance to clinical management decisions.We propose an amendment to the study protocol to study a cohort of patients with COVID 19 and acute kidney injury. We will utilise the same techniques in the main study protocol in order to gain an understanding of the mechanisms of AKI in this group of patients.\n\nSummary of Changes\n1. Addition of 20 patients with confirmed COVID 19 infection. Removal of the shock criteria for this cohort. Removal of all study time points after the first for this subgroup.
REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
18/YH/0371
Date of REC Opinion
15 Oct 2018
REC opinion
Favourable Opinion