Preload-responsiveness
Conditions
Keywords
preload-responsiveness, acute circulatory failure, left ventricular outflow tract velocity time integral, mitral valve velocity time integral, echocardiography
Brief summary
The aim of this is to assess the reliability of the variability of the mitral velocity time-integral with passive leg raising to predict the fluid responsiveness in patients with acute circulatory failure in intensive care.
Detailed description
Adult patients with acute circulatory failure will be included in the study. An initial echocardiography is performed in patients placed in a semi-recumbent position. On the apical views (4 and 5-chamber views), the left ventricular outflow tract velocity time integral (LVOT-VTI) and mitral valve (MV-VTI) velocity time integral are measured (baseline values). Then a passive leg raise test is performed and the parameters (LVOT-VTI and MV-VTI) are measured again. Preload-responsiveness is defined by an increase in LVOT-VTI of at least 10%. In preload-responsive patients, a fluid loading with 500 ml of 0.9% saline administered over 15 minutes is performed. Immediately after fluid therapy, the same parameters are recorded during a third echocardiography. An increase of 10% or more of LVOT-VTI , compared with baseline, defines fluid responsiveness. Patients are monitored using the standard of care practices. Hemodynamic assessment includes repetitive echocardiographic examinations if needed. In patients with shock, invasive blood pressure is monitored with an arterial catheter.
Interventions
DIAGNOSTIC_TESTEchocardiography
Mitral velocity time-integral variability measurement before and after passive leg raising. Mitral velocity time-integral variability measurement after fluid loading in preload-responsiveness patients.
Sponsors
Avicenna Military Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Acute circulatory failure.
Exclusion criteria
* Recent surgery (\<5 days) * Suspected or confirmed intra-abdominal hypertension. * Intracranial hypertension. * Severe mitral valve disease: Severe mitral insufficiency or severe mitral stenosis * Acute cor pulmonale * Atrial fibrillation * Low echogenicity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reliability and accuracy of the change in mitral valve velocity time-integral (cm) to discriminate preload-responsiveness | through study completion, an average of 6 months | Reliability and accuracy of the change in mitral valve velocity time-integral (cm) measured by echocardiography (before and after passive leg raising) to discriminate preload-responsive patients. |
| Reliability and accuracy of the change in mitral valve velocity time-integral (cm) to discriminate fluid-responsiveness | through study completion, an average of 6 months | Reliability and accuracy of the change in mitral valve velocity time-integral (cm) measured by echocardiography (before and after fluid loading with 500 ml of saline) to discriminate fluid-responsive patients. |
Countries
Morocco
Outcome results
None listed