Septic Shock
Conditions
Brief summary
Fluid therapy is an essential component of the management of patients with acute circulatory failure. Nevertheless, unnecessary administration of fluids in non-responders is harmful. Thus, the concept of fluid responsiveness has been suggested to guide fluid administration in critically ill patients to avoid either over or under-transfusion. The aim of this work is to investigate the ability of peripheral perfusion index to predict the hemodynamic response to mini-fluid challenge in patients with septic shock .
Detailed description
The concept of fluid responsiveness has been suggested to guide fluid administration in critically ill patients to avoid either over or under-transfusion. Several methods have been suggested to detect fluid responsiveness. Mini fluid challenge with concomitant monitoring of stroke volume is one of the most robust methods for pre-load challenge. The main foreshortening of mini fluid challenge method is the need for a real-time cardiac output monitor, to track the instantaneous change of stroke vole with changing body position. Finding a surrogate to cardiac output to trace the effect of mini fluid challenge would make the test more applicable without the need for advanced hemodynamic monitors. There is a growing interest in the use of perfusion indices in assessment of fluid responsiveness. Perfusion indices are measures for adequacy of oxygen delivery in peripheral tissues; thus, they were hypothesized to be possible surrogates of cardiac output. Peripheral perfusion index represents the ratio between the pulsatile and non-pulsatile component of the light reaching the pulse oximeter . Peripheral perfusion index has been considered as a numerical non-invasive measure for peripheral perfusion. PPI has the advantage over other perfusion indices that it a non-invasive, user-friendly monitor. The aim of this work is to investigate the ability of peripheral perfusion index to predict the hemodynamic response to mini-fluid challenge in patients with septic shock. Mini-fluid challenge test will be performed by infusion of 200 mL Lactated Ringer's solution over 1 minute. Velocity time integral will be monitored using Transthoracic echocardiography at the left ventricular outflow tract at the apical five-chamber view. Cardiac output will be calculated, and the patient will be considered fluid-responder if cardiac output increased by 10% after fluid challenge.
Interventions
None listed
Sponsors
Cairo University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Septic shock patients
Exclusion criteria
* Evident blood loss * Peripheral vascular disorders * Upper limb injury or burns
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Peripheral perfusion index | 2 hours | It is a number describing the ratio between pulsatile and non-pulsatile blood flow measured by pulse oximeter. It is measured in percent. with the best value of 20% and the worst value of 0.1% |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean arterial blood pressure | 2 hours | Mean arterial blood pressure measured in mmHg |
| Central venous pressure | 2 hours | Central venous pressure measured from a central venous catheter. It is measured in cmH2o |
| Velocity time integral | 2 hours | it is a parameter measured from Doppler across the left ventricular outflow tract. It is calculated by dividing the blood velocity by time and measured in cm |
| Diastolic arterial blood pressure | 2 hours | Diastolic arterial blood pressure measured in mmHg |
| Cardiac output | 2 hours | The amount of blood pumped by the heart in one minute. it is measured as liters per minute |
| Systolic arterial blood pressure | 2 hours | Systolic arterial blood pressure measured in mmHg |
Countries
Egypt
Outcome results
None listed