Effect of Lung Ultrasound-Guided Fluid Deresuscitation on Duration of Ventilation in Intensive Care Unit Patients (CONFIDENCE)

What this Trial Is About

Researchers are evaluating the effect of using lung ultrasound (LUS) to guide fluid removal (deresuscitation) on how long patients need invasive mechanical ventilation in intensive care units (ICUs). This international multicenter randomized clinical trial aims to determine if LUS-guided fluid deresuscitation can reduce the duration of ventilation compared to routine care without LUS. The study includes adult ICU patients who are invasively ventilated and expected to remain on ventilation for more than 24 hours after enrollment. Participants are randomly assigned to one of two groups. The intervention group receives fluid deresuscitation guided by daily lung ultrasound exams performed by trained healthcare providers, assessing lung fluid overload and pleural effusions to adjust fluid removal targets. The control group receives routine fluid deresuscitation managed by the treating physician using standard clinical assessments and tests without lung ultrasound guidance. Both groups follow standard criteria for extubation and ongoing monitoring. The study plans to enroll 1,000 patients. During the study, patients are monitored for safety by an independent board. Lung ultrasound examinations are performed daily in the intervention group until day 28 or hospital discharge to detect fluid changes. Researchers will measure ventilator-free days at 28 days after randomization as the primary outcome, along with secondary outcomes including duration of ventilation, ICU and hospital stay length, mortality rates, reintubation rates, fluid balances, and kidney injury. Participation involves randomization soon after ICU admission and follow-up for up to 28 days with regular clinical assessments and monitoring.

Lung Ultrasound-Guided Fluid Deresuscitation in ICU Patients