Evidence map›Paper›PMID 42010883›Full record

Trial reportCritical care explorations2026

The Effects of Conservative Fluid Management and Active Deresuscitation on Markers of Tissue Perfusion, Kidney Injury, and Vascular Injury in Critically Ill Adults: A Secondary Analysis of the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) Trial.

Ross R McMullan, Christopher McGrath, Neil Cody, John Conlon, Gemma McCamley, Evie Symington, Sarah Scannell, Pappitha Raja, Anthony Rostron, Jonathan Bannard-Smith and 9 more

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Critical care explorations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Ross R McMullanWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.ORCID 0000-0002-3083-6402
Christopher McGrathWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
Neil CodyWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
John ConlonWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
Gemma McCamleyWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
Evie SymingtonWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
Sarah ScannellWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
Pappitha RajaDepartment of Critical Care, Belfast Health and Social Care Trust, Belfast, United Kingdom.
Anthony RostronNewcastle University, Newcastle upon Tyne, United Kingdom.
Jonathan Bannard-SmithManchester University NHS Foundation Trust, Manchester, United Kingdom.
Tamas SzakmányDivision of Infection and Immunity, Cardiff University, Cardiff, United Kingdom.
John TrinderDepartment of Critical Care, South-Eastern Health and Social Care Trust, Belfast, United Kingdom.
Paul JohnstonDepartment of Critical Care, Northern Health and Social Care Trust, Antrim, United Kingdom.
John C MarshallDepartment of Surgery, University of Toronto, Toronto, Ontario, Canada.
Cecilia M O'KaneWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
John BusbyCentre for Public Health, Queen's University of Belfast, Belfast, United Kingdom.
Daniel F McAuleyWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
Andrew J BoyleWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
Jonathan A SilversidesWellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTest the hypothesis that conservative fluid management with active deresuscitation would not adversely affect tissue perfusion or kidney injury and would be associated with reduced vascular injury compared with usual care.

designSecondary analysis of the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) trial.

settingICUs. PATIENTS OR SUBJECTS: Critically ill patients enrolled in the RADAR-2 trial.

interventionsConservative fluid management with active deresuscitation vs. usual care. MEASUREMENTS AND MAIN

resultsMeasures of tissue hypoperfusion (whole blood lactate), acute kidney injury (AKIRisk score and urinary cystatin-C), and vascular injury (plasma hyaluronan, syndecan-1, and angiopoietin-2) were compared between groups. For each analyte, change from baseline was compared between groups and the median inter-group difference at each timepoint was estimated with bootstrapped CIs. Exploratory logistic regression examined associations between plasma biomarker levels (including N-terminal pro-B-type natriuretic peptide [NT-proBNP]), 28-day mortality, and treatment allocation. Whole blood lactate levels were similar between groups at all timepoints. Using change from baseline comparisons, no statistically detectable between-group differences were observed in AKIRisk scores or urinary cystatin-C levels. Plasma vascular injury biomarkers showed no statistically detectable between-group differences at any timepoint. High baseline hyaluronan (adjusted odds ratio [aOR], 5.75; 95% CI, 1.94-17.02; p = 0.002), syndecan-1 (aOR, 8.82; 95% CI, 2.67-29.15; p < 0.001), and NT-proBNP greater than 2500 pg/mL (aOR, 21.48; 95% CI, 3.57-129.41; p < 0.001) were independently associated with increased 28-day mortality. There was no evidence of differential treatment response based on these biomarker levels.

conclusionsConservative fluid management and active deresuscitation were not associated with worsening tissue perfusion or acute kidney injury. A reduction in vascular injury markers was not observed. Given the modest sample size and resultant imprecision, clinically important effects cannot be excluded.

Indexed as

Acute Kidney InjuryConservative TreatmentCritical IllnessFluid TherapyAgedAngiopoietin-2BiomarkersCystatin CFemaleHumansHyaluronic AcidIntensive Care UnitsLactic AcidMaleMiddle AgedResuscitationAngiopoietin-2BiomarkersCystatin CHyaluronic AcidLactic AcidSyndecan-1acute kidney injuryedemafluid therapyglycocalyxischemia

Identifiers

PMID42010883
PMCPMC13098782

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.