Los Angeles

This clinical trial investigates the best way to use prone position placing patients on their stomachs for adults with moderate to severe Acute Respiratory Distress Syndrome ARDS who need mechanical ventilation. Researchers want to find out if longer prone sessions lasting more than 48 hours improve survival compared to daily sessions lasting 16 to 24 hours. The study also evaluates the safety of prolonged prone positioning and its impact on medical problems related to this intervention. Participants are randomly assigned to one of two groups one receiving prolonged prone position sessions lasting at least 48 hours and up to 120 hours until their oxygenation improves, and the other receiving intermittent daily prone sessions lasting between 16 and 24 hours. Both groups may have repeated prone sessions during the first 7 days if their oxygen levels fall below a certain threshold after returning to the supine position. This design allows comparison of continuous versus intermittent prone positioning in managing ARDS. During the study, participants will be followed for up to 90 days to monitor their clinical progress. Researchers will assess outcomes including mortality at 28 and 90 days, ventilator-free days, and hospital-free days at 28 days. Safety and adverse events related to prone positioning will also be recorded. The total participation involves receiving the assigned prone sessions during the first week and ongoing clinical follow-up to evaluate the effectiveness and safety of each approach.

Researchers are studying adults with acute kidney injury AKI who are critically ill and receiving continuous renal replacement therapy CRRT. The study aims to understand how well patients tolerate fluid removal through net ultrafiltration UFNET during CRRT. This is an observational study focusing on how changes in heart function, blood flow, tissue perfusion, and congestion-related signs might predict intolerance to fluid removal before severe low blood pressure occurs. Participants are critically ill adults receiving CRRT with UFNET prescribed by their clinical care team. The study does not change or assign treatments but monitors patients using multiple methods. These include clinical assessments, hemodynamic monitoring, cardiac ultrasound, venous congestion evaluation, peripheral perfusion measurements, biochemical tests, and fluid balance tracking. Data is collected before and during the early phase of fluid removal, with additional recordings if signs of intolerance appear. Participants will be assessed at scheduled times using standard medical records, bedside monitors, laboratory results, and ultrasound exams. The study will track the development of ultrafiltration intolerance within 24 hours of UFNET start. Researchers will analyze various physiological and clinical factors to identify predictors of intolerance. The study may help tailor fluid removal strategies and improve CRRT safety in critically ill patients with AKI. Participation includes monitoring without altering usual care, and data will be kept confidential and anonymized.