Edema, Sepsis
Conditions
Brief summary
Can videomicroscopy of the sublingual microcirculation detect the increase in edema before peripheral edema will appear? By measuring the decrease in vesseldensity after strong positive fluid balances within septic patients versus euvolemic post-cardiac surgery patients. Measuring reactance and resistance (BIVA method) to determine volume status. Primary outcome: \- Total vessel density (TVD) Secondary outcome: * Fluid balance * BIVA measurements (reactance & resistance)
Detailed description
There are a lot of methods to determine if a patient is fluid-responsive, however a moment to stop fluid therapy is lacking. So the purpose of this study is to find a 'stop' moment for fluid therapy before peripheral edema will be present. With sublingual measurements of the vessel density with the Cytocam-IDF, comparing the septic patients with fluid overload , euvolemic post-cardiac surgery patients at the arrival on the ICU and healthy volunteers we can determine if there is a decrease in vessel density during fluid loading. To give a accurate view on fluid overload we include a bio-impedance measurement of reactance and resistance. Fluid balances are recorded very accurate by our electronic patient record.
Interventions
Measuring total vessel density with the Cytocam-IDF camera.
DEVICEBio-impedance measurements.
measuring resistance and reactance with the BIVA method.
Sponsors
Frisius Medisch Centrum
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* after cardiac surgery * septic patient with a fluid balance of 4L +
Exclusion criteria
* recent maxillofacial surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference in vessel density (mm/mm2) of the sublingual microcirculation between the two groups. | Cardiac surgery within 4 hours of ICU admittance, 1 offline total vessel density measurement, Septic patients +/- third day of ICU admittance, 1 offline total vessel density measurement. | With the Cytocam-IDF we make movies off the sublingual microcirculation for 6 seconds on 3 different spots, with offline analysis we calculate a mean total vessel density (total surface of vessels divided by total area surface). The cardiac surgery group will be measured within 4 hours of admittance on the ICU. The septic patients group will be measured on the moment that the highest fluid balance during the ICU stay, so on the moment that there will be started with diuretics of renal replacement therapy to induce a negative fluid balance. |
Secondary
| Measure | Time frame |
|---|---|
| The correlation between a increasing fluid balance and the total vessel density in both groups separately. | The cumulative fluidbalance (L) will be noted at the same moment as the microcirculation movies are made, this will be the cumulative fluid balance as measured on the ICU. |
Countries
Netherlands
Outcome results
None listed