MODS, Sepsis, Shock
Conditions
Brief summary
This is a prospective observational study to observe the diagnostic efficacy of a quantitative ultrasound assessment plan for pathological accumulation in the abdominal cavity space of critically ill patients, and to explore its correlation with patient clinical outcomes.
Detailed description
Intra-abdominal lesions, such as hemorrhage and inflammation/infection, often lead to pathological accumulations, posing serious challenges for critically ill patients. These lesions can rapidly induce intra-abdominal hypertension and organ damage, which may progress to hemorrhagic or septic shock, endangering patients' lives. Intra-abdominal hemorrhage, especially surgery-related hemorrhage, is difficult to detect early, and existing assessment methods like CT scans have limited applicability in critically ill patients. Intra-abdominal infections account for a high proportion of infections in critically ill patients, with concurrent sepsis or shock having high mortality rates. Despite advancements in critical care medicine, the mortality rate from intra-abdominal infections remains stubbornly high. Accurate assessment of the source and extent of infection is crucial for treatment, yet routine physical examinations have low sensitivity in critically ill patients, making imaging examinations the primary method. However, while abdominal CT is considered the gold standard, it is limited by insufficient dynamic monitoring and difficulties in patient transport. Bedside ultrasound plays a significant role in the monitoring of critically ill patients due to its portability, non-invasiveness, and real-time dynamic capabilities. It can assess sources of hemorrhage and infection, quantify the extent of lesions, and monitor hemodynamic changes. Therefore, this study aims to develop a comprehensive ultrasound assessment protocol that covers the peritoneal cavity and posterior peritoneal space. Through a prospective observational study, we aim to validate its sensitivity and specificity in diagnosing pathological accumulations such as intra-abdominal hemorrhage/infection and explore its correlation with patient clinical outcomes.
Interventions
None listed
Sponsors
Ruijin 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 old; * Expected ICU stay ≥ 72 hours; * Meeting one of the diagnostic criteria for intra-abdominal infection: 1) Single organ infection (such as cholecystitis, appendicitis, diverticulitis, cholangitis, pancreatitis, salpingitis, etc.), which may be accompanied by or without peritonitis, even without perforation; 2) Peritonitis, classified as primary, secondary, or recurrent; 3) Intra-abdominal abscess.
Exclusion criteria
* Patients with wounds, redness, swelling, bleeding, or other conditions at the abdominal measurement points that prevent ultrasound assessment; * Patients with intra-abdominal gas accumulation that affects abdominal ultrasound imaging, making ultrasound quantitative scoring impossible; * Patients who have not undergone abdominal CT examination within 72 hours of ICU admission; * Patients who do not consent to participate in this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quantitative CT Scoring for Pathological Accumulations in the Abdominal Cavity Space | up to 3 days after admission to ICU | score range from 0-20, higher scores indicate a worse outcome |
| Quantitative Ultrasound Scoring for Pathological Accumulations in the Abdominal Cavity Space | up to 3 days after admission to ICU | score range from 0-20, higher scores indicate a worse outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| C-reactive protein | up to 3 days after admission to ICU | C-reactive protein in mg/L |
| procalcitonin | up to 3 days after admission to ICU | procalcitonin in ng/L |
| white blood cell count | up to 3 days after admission to ICU | white blood cell count |
| time to achieve enteral nutrition targets | up to 28 days after admission to ICU | time to achieve enteral nutrition targets in hours |
| serum albumin | up to 28 days after admission to ICU | serum albumin in g/L |
| prealbumin | up to 28 days after admission to ICU | prealbumin in mg/L |
| Duration of Continuous Renal Replacement Therapy treatment | up to 28 days after admission to ICU | Duration of CRRT (Continuous Renal Replacement Therapy) treatment in hours |
| duration of mechanical ventilation | up to 28 days after admission to ICU | duration of mechanical ventilation in hours |
| Time to initiate enteral nutrition | up to 3 days after admission to ICU | Time to initiate enteral nutrition after admission to ICU in hours |
| prognosis | up to 28 days after admission to ICU | survival or death when transfer out of the ICU |
| acute physiology and chronic health evaluation II score | up to 3 days after admission to ICU | score range from 0-71, higher scores indicate a worse outcome |
| Sequential Organ Failure Assessment | up to 3 days after admission to ICU | score range from 0-15, higher scores indicate a worse outcome |
| Abdominal Gastrointestinal Index score | up to 3 days after admission to ICU | score range from 0-4, higher scores indicate a worse outcome |
| Abdominal Gastrointestinal Index Ultrasonography Score | up to 3 days after admission to ICU | score range from 0-10, higher scores indicate a worse outcome |
| Gastrointestinal Ultrasound Scoring score | up to 3 days after admission to ICU | score range from 0-10, higher scores indicate a worse outcome |
| semi-quantitative ultrasound score of gastric content | up to 3 days after admission to ICU | score range from 0-2, higher scores indicate a worse outcome |
| length of ICU stay | up to 28 days after admission to ICU | length of ICU stay in days |
| Intra-abdominal pressure | up to 3 days after admission to ICU | Intra-abdominal pressure in mmHg |
Countries
China
Contacts
Primary Contactweiqing Zhang, Ph.D
Outcome results
None listed