Cardiovascular Physiological Phenomena, Intensive Care Unit Syndrome
Conditions
Brief summary
Echocardiography is recommended for the hemodynamic management of patients with shock. Recently, a new echocardiographic method has been proposed that provides a non-invasive measurement of myocardial work incorporating different components, namely total myocardial work (GWI), constructive myocardial work (GCW), lost myocardial work (GWW) and effective myocardial work (GWE). Echocardiographic measurement of myocardial work takes into account both myocardial deformation and left ventricular afterload (estimated by measuring systolic blood pressure) and, unlike the measurement of left ventricular ejection fraction and global longitudinal strain, could be less dependent on cardiac load conditions, particularly left ventricular afterload. To date, non-invasive measurement of myocardial work has never been validated in critically ill patients, and no study has assessed the effects of different therapies (fluids administration, administration of norepinephrine) on the different components of myocardial work in patients admitted to intensive care unit.
Interventions
OTHERFluid administration
Patients will receive fluid administration (500 mL of saline over 30 minutes). The indication of fluid administration will be left to the discretion of the attending physician.
OTHERNorepinephrine administration or increase in norepinephrine dosage
Patients will receive norepinephrine or norepinephrine dosage will be increased if necessary to achieve the appropriate mean arterial pressure level. The indication of norepinephrine administration or increase in norepinephrine dosage will be left to the discretion of the attending physician.
Sponsors
Centre Hospitalier Universitaire de Nice
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Indication to fluid administration left to the discretion of the attending physician * Indication to norepinephrine administration or increase in norepinephrine dosage left to the discretion of the attending physician.
Exclusion criteria
* Patients under protection. * Patients with do not ressuscitate order. * Patients with severe left-side or right-side valvulopathy. * Patients with atrial fibrillation. * Patients with ventricular aneuvrysm or severe regional wall motion abnormalities. * Patients with a pacemaker. * Patients' objections to the collection of their health data.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Determine the feasibility of echocardiographic measurement | through study completion, an average of 1 year | The primary outcome will be assess by evaluating the proportion of patients in whom non-invasive echocardiographic measurement of myocardial work is obtained. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| measurement of myocardial by cardiac ultrasound norepinephrine administration | through study completion, an average of 1 year | The measurement of myocardial work will be performed non-invasively by cardiac ultrasound. The secondary outcomes will be assess the impact of norepinephrine administration on the different components of myocardial work. as follows: (i) norepinephrine-induced changes in the different components of myocardial work, (ii) concordance between changes in myocardial work and changes in cardiac output induced by norepinephrine and (iii), the ability of the different components of myocardial work to predict fluid responsiveness. |
| measurement of myocardial by cardiac ultrasound during fluid administration | through study completion, an average of 1 year | The measurement of myocardial work will be performed non-invasively by cardiac ultrasound. The secondary outcomes will be assess the impact of fluid administration on the different components of myocardial work. as follows: (i) fluid-induced changes in the different components of myocardial work, (ii) concordance between changes in myocardial work and changes in cardiac output induced by fluid administration (iii), the ability of the different components of myocardial work to predict fluid responsiveness. |
Countries
France
Contacts
Primary ContactMathieu Jozwiak, MD
Outcome results
None listed