BERTRAND Pierre-MarieClermont Ferrand

Article originalEtude pidmiologique, prospective, multicentrique, contrl, randomis, sans aveugleClinicalTrial.gov : Primary Hypothesis: An intensive management strategy for renal support in critically ill patients with acute renal failure decreases mortality as compared to less intensive (conventionally recommended) management strategies for renal replacement therapy.Secondary Hypotheses: An intensive management strategy for renal support in critically ill patients with acute renal failure will shorten the duration of ARF, decrease the incidence and duration of non-renal complications and is cost-effective as compared to less intensive (conventionally recommended) management strategies for renal replacement therapy.Critre principal : [] intensive management strategy for renal support in critically ill patients with acute renal failure decreases mortality []

Critre PrincipalMortalit toute cause J60Critres secondaires : Mortalit HospitalireRcup. fct rnale (ClCr > 20mL/min)Dure dEERDure sjour en RaJours sans dysfonction dorganeRetours domicile sans HDI

StatistiquesNombre de patients inclure : 1164 pour = 0,05 bilatral; 1- = 0,9; 10% de diffrenceAnalyses intermdiaires prvus adaptes (Haybittle and Peto)Mortalit J+60Rgression logistique par strate (oligurie, sexe, SOFA CV, sepsis)KaplanMeierCritre secondaireAnalyse de Variance (ANOVA)

Matriel et Mthode

Flowchart

Rsultats

Discussion

Inclusion/Exclusion

2 bras htrognesHDI /j = HFC 35mL/kg/j = SLED /jHDI /2j = HFC 20mL/kg/j = SLED /2j?

Protocole Complexe

HFCIntensiveLess Intensive

HDIIntensiveLess Intensive= 3,9/sem= 7,8/sem

Complications

Contrle de la VolmieIntensiveLess Intensive

Biais minimumdead

Validit externeHypothse physiologiquePertienteCohrence avec la littratureSchiffl, NEJM 02 (HDI /j)Pannu, JAMA 08 (HDI = HFC 35 mL/kg/j)Tonelli, AJKD 02 (HDI = HFC )Bouman, Crit Care Med (Early vs. low vs. hight volume HFC)Ronco, Lancet 00 (20 vs. 35 vs. 40 mL/kg/h)

En Conclusion

Rponse la questionLtude apporte une rponse la question pose.La question modrment pertinenteLtude ne permet pas de conclure

Consquence

Je ne modifie pas ma pratique quotidienne

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