UltraSound Evaluation of Fluid tOleRanCE for Acute Kidney Injury

Protocol adherence

Fluid expansion with isotonic crystalloids is a first-line intervention in the treatment of
 patients with acute kidney injury (AKI). While it is generally accepted that the timely
 correction of kidney hypoperfusion will minimize the extent of injury as well as potentially
 facilitate recovery, there are potential harms involved in indiscriminate administration of
 intravenous fluids. Although anticipating fluid tolerance is part of the clinical evaluation
 of a patient for whom intravenous fluid therapy is considered, it has been suggested that
 using Point-Of-Care ultrasound (POCUS) may enable the early identification of patients with a
 high-risk of congestive complications and guide clinical decisions with greater precision[1].
 However, it has not been shown that providing this information in the context of AKI result
 in a change in management or a prevention of complications.
 
 This single-center pilot randomized controlled trial aim to determine the feasibility of
 comparing a management including a POCUS evaluation of fluid tolerance to usual care in
 non-critically ill patients with AKI. In the intervention group, a POCUS evaluation will be
 performed and interpreted by experienced staff producing a report that will be presented to
 the attending care team. This assessment will be repeated 48-72 hours later. The primary aim
 of the study will be to establish the feasibility of this intervention. Secondary objectives
 will include determining the difference between the intervention arm and the control arm in
 relationship with fluid administration, diuretic use, evolution of kidney function, and
 intensification of care.