Acute Heart Failure, Congestive Heart Failure, Hypervolemia, Hypovolemia, Infection, Septic Shock
Conditions
Brief summary
The overall goal of this multicenter project is to characterize the expected normal range of Peripheral IntraVenous Volume Analysis (PIVA) values during a euvolemic state, and how those ranges may be altered by comorbidities; the relationship between PIVA and intravenous volume administration during resuscitation of infected patients with presumed hypovolemia; and, the relationship between PIVA and volume decreases during diuresis in acute heart failure patients with hypervolemia.
Detailed description
The determination of volume status remains a clinical challenge in medicine. Patients may develop hypovolemia (too little fluids in the vascular space) due to conditions such as hemorrhage, dehydration, or infection with vascular leak. Alternatively, patients may become hypervolemic (too much fluids in the vascular space), due to conditions such as heart failure, renal failure, or iatragenic over-resuscitation all of which overwhelm the kidney's ability to regulate intravascular volume status. In clinical practice, clinicians strive to return patients to euvolemia (the right volume status) through the administration of intravenous fluids or diuretics which remove fluids to achieve homeostasis. While there are a number of proposed clinical exam findings (e.g. dry mucous membranes or skin turgor), measurements (e.g. central venous pressure), or laboratory tests (e.g. blood urea nitrogen), none are precise or universally accepted as reliable methodologies to assess volume status. The goal of this study is to perform a prospective observational study on three distinct cohorts during ED presentation to assess the variability and performance of PIVA in tracking volume status.
Interventions
Non-invasive measurement of peripheral intravenous waveform analysis (PIVA) obtained by connecting an Edwards standard transducer to a universal adaptor or stopcock on a peripheral IV
PROCEDURENon-invasive fluid response measure
To measure the stroke volume and changes in stroke volume in response to a passive leg raise (PLR) maneuver and fluid administration.
DIAGNOSTIC_TESTPassive leg raise (PLR)
Test to predict cardiac output and fluid responsiveness
Sponsors
Baxter Healthcare Corporation
Beth Israel Deaconess Medical Center
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Control Cohort (Presumed Euvolemia) Inclusion Criteria: * Age \> 18 years old * Assessed as euvolemic by treating physician
Exclusion criteria
* History of any type of decreased oral intake or volume loss (e.g. diarrhea, vomiting, etc) * History of a fever * History of bleeding * Any acute illness expected to alter volume * Known or suspected pregnancy * Active irregular heart rhythm * In the opinion of the treating physician, no anticipated intravenous fluid administration * History of chronic or end stage renal disease * Liver failure * History of Acute heart failure * Presence of abnormal vital signs (90 \< HR \< 60; 180 \< SBP \< 110, respiratory rate \> 20, pulse ox \< 92% or need for supplemental oxygen, 99.0 \< temperature \< 96). 2 additional group will be included in this euvolemic group * Non-elderly patients (age \< 50 year) without any comorbid illnesses and * Age \>65 * Diabetes on medications * Hypertension on medications * Vascular disease defined by history of peripheral vascular disease, stroke, MI Note: patients that receive \>250 cc of IVF will be excluded from analysis. Infection Cohort (Presumed Hypovolemia) Inclusion Criteria: * Age \> 18 years old * An accessible intravenous catheter is in place * Known or suspected infection as assessed by the clinical team * Intention to admit to the hospital * Anticipated administration of intravenous fluids per clinical team
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Association between PIVA measurement and fluid status (net gain vs net loss) | Baseline to 6 hours for euvolemic and hypovolemic cohort, and baseline to 72 hours for hypervolemic cohort | Change in fluid status over the first 6 hours as measured by weight and urine output and pressure status from the Edwards transducer |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Response to Passive leg raise | For the euvolemic cohort, baseline to 2 hours; For hypovolemic, cohort baseline to 6 hours; for the hypervolemic cohort, baseline up to 72 hours | Compute the change in PIVA measurement between before and after the passive leg raise challenge within each cohort |
| Association between PIVA and non-invasive monitoring responsiveness to passive leg raise | Baseline up to 72 hours | Compare change in PIVA measurements to non-invasive monitoring measurements before and after passive leg raise and before and after fluid boluses |
Countries
United States
Outcome results
None listed