Hemodynamic Instability
Conditions
Brief summary
Traditional methods for intravascular volume status assessment include physical examination, raised leg test, central venous pressure (CVP) and pulmonary artery catheters occlusion pressure (PAWP). Central venous pressure and pulmonary artery occlusion pressure are invasive and associated with significant complications. More recently, a number of less invasive techniques have been introduced, but they lack standardization and reliability. Ultrasonically, inferior vena cava collapsibility can detect hypovolemia non-invasively.
Detailed description
The aim of this study is that measurement of subclavian vein collapsibility index(SCV-CI) could be potential adjunct to IVC-CI where the IVC visualization is impaired or not possible . -Finding a non-invasive reliable accurate method for evaluation of intravascular volume and response to volume resuscitation.
Interventions
DIAGNOSTIC_TESTinferior vena cava collapsibility
inferior vena cava diameters is obtained in the supine position with a convex probe .The probe is placed in the subxiphoid region or the right anterior midaxillary plane.The sagittal section of IVC is imaged. M-mode probe is used to identify the measurement of minimum and maximum venous dimensions over the respiratory cycle using the 3.5-5 MHz phased array probe. To standardize the measurements, measuring of the IVC diameter is performed at 2 cm caudal of the junction point of the right atrium and IVC. The difference between the maximum (D max) and minimum (D min)diameters of the target vein is normalized according to the standard formula to yield the collapsibility index (CI).
DIAGNOSTIC_TESTsubclavian vein collapsibility
Right SCV diameters is checked in the supine position using a high frequency linear array probe (6-13 MHz) and M-mode. To standardize the measurements, the probe is placed beneath the proximal part of the middle part of the clavicle perpendicular to long-axis of the SCV to obtain the best cross-sectional view of the vien. After the target vein is localized , the dynamic diameter change is recorded using M-mode to identify and measure the minimum and maximum venous diameters.To calculate SCV collapsibility index, the standard formula is used.
DIAGNOSTIC_TESTcentral venous pressure
ultrasound guided 7.5-F central venous catheter is introduced via right internal jugular vein under local analgesia with 2% lidocaine for measuring the CVP.
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* 1\. American society of anaesthesiologists physical status grade I and grade II . 2\. Elective laparotomy. 3. Supine position
Exclusion criteria
1. Patient refusal . 2. Portal hypertension . 3. Severe peripheral vascular diseases. 4. Obstructive lung diseases . 5. Right sided heart failure , arrhythmia and valvular heart heart diseases . 6. Body mass index \>35 kg/m2
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| inferior vena cava collapsibility index changes | intraoperative changes:1st basal before induction of anesthesia, 2nd before start of surgery, 3rd after10 ml/kg ringers preload, 4th 5 minutes before extubation. | ultrasound M mode maximum minus minimum over maximum then multiply by 100 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| central venous pressure changes | intraoperative changes:1st basal before induction of anesthesia, 2nd before start of surgery, 3rd after 10 ml/kg ringers preload, 4th 5 minutes before extubation. | centimeter water |
| heart rate changes | intraoperative changes:1st basal before induction of anesthesia, 2nd before start of surgery, 3rd after 10 ml/kg ringers preload, 4th 5 minutes before extubation. | beat per minute |
| mean blood pressure changes | intraoperative changes:1st basal before induction of anesthesia, 2nd before start of surgery, 3rd after 10 ml/kg ringers preload, 4th 5 minutes before extubation. | millimeter mercury |
| subclavian vein collapsibility index changes | intraoperative changes:1st basal before induction of anesthesia, 2nd before start of surgery, 3rd after 10 ml/kg ringers preload, 4th 5 minutes before extubation. | ultrasound M mode maximum minus minimum over the maximum then multiply by 100 |
| blood loss | intraoperative | milliliter |
| urine output | intraoperative | milliliter |
| fluid administration | Intraoperative | milliliter |
Countries
Egypt
Outcome results
None listed