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Dehydration in ChildrenEarly Phase 1BRiSKNCT05285371

Boluses of Ringer's in Surgical Kids (BRiSK Study)

A Early Phase 1 study testing Urinalysis (UA), Complete Metabolic Panel (CMP) and Glucose Stick Test (d-Stick) in people with Dehydration in Children and Fluid Therapy, run by Children's Hospital of Philadelphia at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Traditional protocols for intravenous fluid administration in children who have undergone a major abdominal or thoracic operation are based on a landmark paper published in 1957 by Holliday and Segar. Read more about this study

Who is it for?
Ages 1 year to 21 yearsHealthy volunteers can take part
Conditions the study is for
Dehydration in Children, Fluid Therapy
What is being tested?
Urinalysis (UA), Complete Metabolic Panel (CMP) and Glucose Stick Test (d-Stick)
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
70 participants
Where
1 siteUnited States
Study dates
22 Feb 2022to 1 Aug 2024
Phase
Early Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year to 21 years
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult

Who may be able to join

  • Males or females age 12 months to 21 years.
  • Weight >= 8 kg.
  • Patients with an uncomplicated abdominal or thoracic surgical procedure in which the expected postoperative length of stay is anticipated to be at least 2-5 days.
  • Patients admitted to a regular bed following surgery.
  • Patients who will be inpatient for approximately 4-8 days postoperatively.
  • Parental/guardian permission (informed consent).

Who cannot join

  • Patients with a history of diabetes, seizures, hyperglycemia, and hypoglycemia.
  • Patients prescribed insulin.
  • Patients receiving parenteral nutrition.
  • Patients with excessive GI losses (small bowel obstruction, severe diarrhea, large-volume ascites or drainage).
  • Complicated surgery that requires an ICU or ICU transfer immediately after surgery.
  • Patients with any form of hypersensitivity to the study fluids.
Show all 16Show fewer
  • Laboratory abnormalities that indicate clinically significant hematologic, hepatobiliary, or renal disease:
  • Serum Sodium <130 or >145 mmol/L
  • Serum Potassium <3.0 or >5.0 mEq/L
  • Serum Chloride <90 or >110 mEq/L
  • Serum Creatinine ≥ 1.6 mg/dL
  • Serum Glucose <60 or >180 mg/dL
  • Alanine Aminotransferase >200 U/L
  • Total Bilirubin >12.0 mg/dL
  • Pregnant or lactating females.
  • Parents/guardians or subjects who, in the opinion of the Investigator, may be non-compliant with study schedules or procedures.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

Other trials in United States

About this study

Official title: Intravenous Hydration After Surgery Using Boluses of Balanced Salt Solution

Traditional protocols for intravenous fluid administration in children who have undergone a major abdominal or thoracic operation are based on a landmark paper published in 1957 by Holliday and Segar. The basic tenets include: (1) Continuous intravenous fluid administration; (2) Total fluid volume based on the "4:2:1" rule; (3) Use of hypotonic electrolyte solutions, most commonly 0.45% sodium chloride (NaCl) + 20 milliequivalents per liter (mEq/L) potassium chloride (KCl); and (4) Inclusion of 5% dextrose to increase the osmolarity of the infusate and to help prevent ketosis and acidemia.

Read the detailed description

Recent studies have questioned the validity of each of these tenets. Maintenance rate as defined by Holliday \& Segar is postulated to be in excess of pediatric patients' post-surgical fluid needs. The investigators propose a novel protocol for the administration of IV fluids to children after major abdominal or thoracic surgery that includes: (1) Intermittent boluses; (2) Total volume administered in 24 hours closer to 2/3 of the traditional maintenance fluid requirements; and (3) Use of a balanced salt solution (Lactated Ringer).

Being tested
Urinalysis (UA), Complete Metabolic Panel (CMP), Glucose Stick Test (d-Stick), Medical Chart Review
Keywords
Hydration, Fluids, Lactated Ringer's, Hyponatremia, Dehydration, Post Operative, Pediatrics, Children, Intravenous Fluid Therapy
Medical subject headings
Hyponatremia, Dehydration

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Urinalysis (UA)Diagnostic test

    Urinalysis will be performed twice daily starting on Postoperative Day 0.

  • Complete Metabolic Panel (CMP)Diagnostic test

    A CMP will be performed on Postoperative Day 2 and Postoperative Day 4.

  • Glucose Stick Test (d-Stick)Diagnostic test

    A d-Stick will be performed twice daily except on Postoperative Day 2 and Postoperative Day 4 as the CMP includes serum glucose levels.

  • Medical Chart ReviewOther

    A medical chart review will be performed for all subjects enrolled.

Study groups in NCT05285371
Study groupRoleWhat they receive
CONT GroupPlacebo comparatorCONT group will receive standard traditional intravenous fluid of D50.45% NaCl + 20 mEq/L KCl at 2/3 maintenance rate.
Receives: Diagnostic Test: Urinalysis (UA); Diagnostic Test: Complete Metabolic Panel (CMP); Diagnostic Test: Glucose Stick Test (d-Stick); Other: Medical Chart Review
BOL GroupExperimentalBOL group will receive intravenous boluses of Lactated Ringer's three times daily at 2/3 maintenance rate.
Receives: Diagnostic Test: Urinalysis (UA); Diagnostic Test: Complete Metabolic Panel (CMP); Diagnostic Test: Glucose Stick Test (d-Stick); Other: Medical Chart Review

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Fluid Adherence to Study Protocol

    Feasibility will be determined if 85% of enrolled study participants receive at least 75% of the expected study fluid in accordance to study protocol.

    Measured: 4 Days

  2. Feasibility of Measuring and Collecting Urine Output

    Feasibility will be determined if at least 90% of enrolled study participants have accurate urine collection and urine measurements during the study treatment phase.

    Measured: 4 Days

Secondary outcomes (2)
  1. Feasibility of Study Laboratory Tests - CMP, d-Stick, Urinalysis

    Feasibility will be determined if at least 70% of enrolled study participants have at least 75% of study laboratory tests collected and recorded during the study treatment phase.

    Measured: 4 Days

  2. Feasibility of Randomization

    Feasibility will be determined if at least 85% of eligible study participants are subsequently enrolled, consented, and randomized during their pre-operative phase of care.

    Measured: Baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Mar 2022
  2. Study start22 Feb 2022
  3. Primary completion19 Apr 2023
  4. Study completion1 Aug 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Early Phase 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Study participants will be randomized into one of two groups - Continuous (CONT) or Bolus (BOL). CONT group will receive traditional continuous D50.45% NaCl + 20 mEq/L KCl solution at 2/3 maintenance rate. BOL group will receive intravenous boluses of Lactated Ringer\&#39;s at 2/3-maintenance rate.
Masking
None (open label)
Enrolment
70 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05285371
Sponsor's protocol ID
21-019180
Acronym
BRiSK
Status last verified
Sep 2024
First submitted
9 Mar 2022
Last updated
19 Sep 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • McNab S. Intravenous maintenance fluid therapy in children. J Paediatr Child Health. 2016 Feb;52(2):137-40. doi: 10.1111/jpc.13076.

    PubMed 27062616
  • Rooholamini SN, Clifton H, Haaland W, McGrath C, Vora SB, Crowell CS, Romero H, Foti J. Outcomes of a Clinical Pathway to Standardize Use of Maintenance Intravenous Fluids. Hosp Pediatr. 2017 Dec;7(12):703-709. doi: 10.1542/hpeds.2017-0099.

    PubMed 29162640
  • Neville KA, Sandeman DJ, Rubinstein A, Henry GM, McGlynn M, Walker JL. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. J Pediatr. 2010 Feb;156(2):313-9.e1-2. doi: 10.1016/j.jpeds.2009.07.059. Epub 2009 Oct 9.

    PubMed 19818450
  • Bagri NK, Saurabh VK, Basu S, Kumar A. Isotonic versus Hypotonic Intravenous Maintenance Fluids in Children: A Randomized Controlled Trial. Indian J Pediatr. 2019 Nov;86(11):1011-1016. doi: 10.1007/s12098-019-03011-5. Epub 2019 Jul 6.

    PubMed 31280410
  • Morgan JA. Question 2: Should 0.9% saline be used for maintenance fluids in hospitalised children? Arch Dis Child. 2015 Jul;100(7):715-7. doi: 10.1136/archdischild-2015-308821. Epub 2015 May 20. No abstract available.

    PubMed 25994003
  • Moritz ML. Syndrome of Inappropriate Antidiuresis. Pediatr Clin North Am. 2019 Feb;66(1):209-226. doi: 10.1016/j.pcl.2018.09.005.

    PubMed 30454744
  • Feld LG, Neuspiel DR, Foster BA, Leu MG, Garber MD, Austin K, Basu RK, Conway EE Jr, Fehr JJ, Hawkins C, Kaplan RL, Rowe EV, Waseem M, Moritz ML; SUBCOMMITTEE ON FLUID AND ELECTROLYTE THERAPY. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018 Dec;142(6):e20183083. doi: 10.1542/peds.2018-3083.

    PubMed 30478247
  • Friedman JN, Beck CE, DeGroot J, Geary DF, Sklansky DJ, Freedman SB. Comparison of isotonic and hypotonic intravenous maintenance fluids: a randomized clinical trial. JAMA Pediatr. 2015 May;169(5):445-51. doi: 10.1001/jamapediatrics.2014.3809.

    PubMed 25751673
  • Moritz ML, Ayus JC. Hospital-acquired hyponatremia--why are hypotonic parenteral fluids still being used? Nat Clin Pract Nephrol. 2007 Jul;3(7):374-82. doi: 10.1038/ncpneph0526.

    PubMed 17592470
  • Oh GJ, Sutherland SM. Perioperative fluid management and postoperative hyponatremia in children. Pediatr Nephrol. 2016 Jan;31(1):53-60. doi: 10.1007/s00467-015-3081-y. Epub 2015 Mar 18.

    PubMed 25784018
  • Abdessalam S. Hypotonic versus isotonic maintenance fluid administration in the pediatric surgical patient. Semin Pediatr Surg. 2019 Feb;28(1):43-46. doi: 10.1053/j.sempedsurg.2019.01.007. Epub 2019 Jan 23.

    PubMed 30824133
  • McNab S, Ware RS, Neville KA, Choong K, Coulthard MG, Duke T, Davidson A, Dorofaeff T. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children. Cochrane Database Syst Rev. 2014 Dec 18;2014(12):CD009457. doi: 10.1002/14651858.CD009457.pub2.

    PubMed 25519949
  • Easley D, Tillman E. Hospital-acquired hyponatremia in pediatric patients: a review of the literature. J Pediatr Pharmacol Ther. 2013 Apr;18(2):105-11. doi: 10.5863/1551-6776-18.2.105.

    PubMed 23798904
  • Moritz ML, Ayus JC. Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics. 2003 Feb;111(2):227-30. doi: 10.1542/peds.111.2.227.

    PubMed 12563043
  • Malbrain MLNG, Langer T, Annane D, Gattinoni L, Elbers P, Hahn RG, De Laet I, Minini A, Wong A, Ince C, Muckart D, Mythen M, Caironi P, Van Regenmortel N. Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA). Ann Intensive Care. 2020 May 24;10(1):64. doi: 10.1186/s13613-020-00679-3.

    PubMed 32449147

Questions about this trial

What is this clinical trial studying?

A Early Phase 1 study testing Urinalysis (UA), Complete Metabolic Panel (CMP) and Glucose Stick Test (d-Stick) in people with Dehydration in Children and Fluid Therapy, run by Children's Hospital of Philadelphia at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Fluid Adherence to Study Protocol (time frame: 4 Days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05285371, which also lists 20 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Sep 2024.

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