Bitker et al. report the GO NEUTRAL randomized clinical trial results, which investigated fluid balance neutralization guided by functional hemodynamic monitoring (FHM) protocol versus a standard of care in critically ill patients with AKI and acute circulatory failure requiring continuous renal replacement therapy (CRRT).

The trial was a multicenter, open-label, parallel-group study involving 55 patients receiving vasopressors and CRRT. Participants were randomized to receive either UFNET ≥ 100 mL/h adjusted using an FHM protocol (intervention) or a UFNET rate of ≤ 25 mL/h (control).

The primary outcome was cumulative fluid balance at 72 h, analyzed in a modified intention-to-treat population.

The authors found that the 72-h cumulative fluid balance was –2650 (interquartile range [IQR], – 4,574 to – 309) mL in the intervention group and 1841 (IQR, 821 to 5327) mL in the control group, a statistically significant difference.

However, there was no difference in secondary outcomes of hemodynamics, oxygenation, hypotension episodes at 72 h, and mortality between the two groups.

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