Sepsis With Hemodynamic Instability
Conditions
Keywords
Aortic ITV, Pulmonary ITV, Cardiac ultrasound, Hemodynamic ultrasound, Vascular filling, Sepsis, Emergency medicine, Recommendations
Brief summary
This is a multicenter study conducted in the emergency department of the Nantes University Hospital and the Confluent Private Hospital, over a period of 5 months, based on hemodynamic ultrasound. For each patient admitted to an emergency department with a sepsis syndrome requiring vascular filling, the pulmonary ITV and the aortic ITV were measured at each phase of vascular filling. This is a non-interventional study, the management of patients will not differ from usual practices and vascular filling should not be delayed in any case. Emergency doctors who are already experts in ultrasound, monitoring vascular filling by measuring the aortic ITV, will have to measure the pulmonary ITV after each filling of 250cc of Ringer's Lactate in 10 minutes with a limited amount of time. The evolution of ITV measurements and vital parameters should be recorded for each patient. In order to ensure quality, the emergency doctors will first receive a short training (presentation of the study and review of the measurements requested). In addition, measurement records will be analyzed at random. At the end of this study, the correlation between the variation of the aortic and pulmonary ITV could be compared. The objective would be to promote the monitoring of these unstable patients via the pulmonary ITV. This measurement would be easier to perform than the aortic ITV, which is currently only performed by emergency doctors who are experts in hemodynamic ultrasound.
Interventions
None listed
Sponsors
Nantes University Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
: * Age\> 18 years * Patient with suspected infectious syndrome * qSOFA \>= 2 * Tachycardia\>120 and/or PAS \< 100mm Hg / MAP \<60 mmHg
Exclusion criteria
: * Atrial fibrillation arrhythmia * Vascular filling \> 500 ml before hemodynamic evaluation by echo cardiography * Perfusion of catecholamine (norepinephrine, epinephrine, or dobutamine) at the time of inclusion in the study (before hemodynamic assessment by echo cardiography) * Patient sedated and on positive pressure ventilation, including NIV * Tamponade due to a compressive pericardial or pleural effusion * Patient with known pre-capillary PAH \> 50 mmHg PAPS * Presence of suspected acute valvulopathy requiring immediate cardiological expertise * Absence of an acoustic window allowing the evaluation of the aortic or pulmonary ITV * Minor patients, adults under guardianship, protected persons
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Demonstration of a correlation between changes in pulmonary ITV secondary to vascular filling and reference values represented by changes in subaortic ITV. | 5 months | Aortic ITV and pulmonary ITV |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Investigate whether pulmonary ITV is more feasible than aortic ITV. | 5 months | Proportion of cases where Aortic ITV measurement is not feasible as opposed to pulmonary ITV. |
| Exploratory search for an indicator threshold for pulmonary ITV corresponding to the 10% threshold of aortic ITV (provided that pulmonary ITV and aortic ITV are correlated) | 5 months | Pulmonary ITV and Aortic ITV |
Countries
France
Outcome results
None listed