Cardiac Output Measurement
Conditions
Keywords
diagnosis of circulatory failure, multiple failures in critical care
Brief summary
Cardiac output (CO) monitoring is recommended for the most serious and multiple-failure patients in critical care and allows the diagnosis of acute circulatory failure as well as its etiology and also allows the monitoring of treatments. However, although allowing an adaptation of hemodynamic treatments and being integrated into a therapeutic personalization approach in situations of acute circulatory failure, the measurement of CO is conditioned by the availability of devices, by their sometimes problematic invasiveness, as well as their cost. In addition, the discontinuous measurement of CO by echocardiography is made difficult in the context of resuscitation with patients who are less mobilizable and less echogenic.
Detailed description
The subcostal assessment route is the classic emergency route. It allows for the analysis of the basic segmental kinetics of the left ventricle, an analysis of the Left Ventricular Ejection Fraction (LVEF), the search for pericardial effusion or even tamponade, or the search for right ventricular dilation. A measurement of CO via the right ventricular outflow tract using transthoracic echocardiography has never been described in the literature, although it is feasible, based on the same mathematical rationale as the standard measurement of cardiac output via the left ventricular outflow tract (which takes into account the diameter of the outflow tract and the subvalvular time-velocity integral \[TVI\]). Since at all times the left (systemic) CO is equal to the right (venous return) CO, it is therefore possible to consider a measurement of CO via the subcostal route. By not complicating the standard care of patients in critical care, especially in situations of acute circulatory failure, and by adding only a few seconds or even minutes to an examination already recommended and routine in critical care, this evaluation approach seems interesting given the need and the recommendations in force on the monitoring of patients in intensive care and more particularly of DC.
Interventions
OTHERDiscontinuous subcostal echocardiographic cardiac output assessment
Right Ventricular Outflow Chamber Diameter (RVOD) and Left Ventricular Outflow Chamber Diameter (LVOD) assessments via subcostal approach
Sponsors
University Hospital, Rouen
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patient (Age ≥ 18 years) * Patient admitted to the intensive care unit at Rouen University Hospital. * Transthoracic echocardiography (TTE) is required upon admission or during the patient's stay for diagnostic assessment and/or therapeutic monitoring.
Exclusion criteria
* Person deprived of liberty by an administrative or judicial decision or person placed under judicial protection/guardianship or curatorship * Patient not affiliated with the social security system * Refusal by the patient or trusted person if the patient is incapable of expressing consent * Pregnant woman * Dying patient
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Measurement of Cardiac Output (CO) via the subcostal route | At Enrollment visit and DAY 28 | To assess the concordance of the measurement of cardiac output in the ejection chamber of the right ventricle (DC-CEVD, innovative method) with that of cardiac output in the ejection chamber of the left ventricle (DC-CEVG, reference method) on subcostal transthoracic ultrasound (TTE). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Compare the measurement success rate of DC-CEVD to that of DC-CEVG. | At Enrollment visit and DAY 28 | Evaluate the success of cardiac output measurement, defined by the fact of rendering a flow measurement |
| To assess the concordance of DC variation during preload-dependence search maneuvers (passive leg raise) in intubated and ventilated patients between DC-CEVD and DC-CEVG measurements. | At Enrollment visit and DAY 28 | Evaluation of DC Variation during the preload-dependence search maneuver: passive leg raise test and 1-minute DC measurement according to the two modalities (DC-CEVD and DC-CEVG measurements). |
| DC measurement by transpulmonary thermodilution device | At Enrollment visit and DAY 28 | Search for the best concordance of the DC-CEVD to the Plan for Continuity of Circulation and Oxygenation (PCCO) and of the DC-CEVG to the PCCOi in a patient who has a transpulmonary thermodilution device with analysis of the pulse wave contour (PCCO), (PiCCO2), |
Countries
France
Contacts
Primary ContactThomas TM MAUDHUIZON, Doctor
Outcome results
None listed