Fluid Responsiveness Predictability, Fluid Resuscitation
Conditions
Keywords
fluid responsiveness, echocardiography, Passive Leg Raising, Mini Fluid Challenge
Brief summary
Fluid administration is the first-line treatment in hypovolemic states in critically ill patients. Prediction of fluid responsiveness is possible with echocardiography by assessing the variation of the sub-aortic velocity-time integral (AoVTI) during a passive leg raising test (PLR) or Mini-fluid challenge. However, VTI-Ao measurement is not feasible in all patients due to poor echogenicity. Validation of new fluid-responsiveness indices may facilitate the evaluation in this patient population. Among the available indices, variation of the sub-pulmonary VTI is a potential criterion.
Interventions
Fluid infusion of 500 mL of a crystalloïd solution is performed for patients with signs of hypovolemia
Sponsors
Hospital Nord
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient with measurable sub-pulmonary VTI in at least one of the two windows: parasternal short-axis or subcostal. * Patient with measurable sub-aortic VTI in apical 4-chamber view before and after PLR maneuver. * Patient with suspected hypovolemia or whose hemodynamic status justifies vasopressor infusion.
Exclusion criteria
* Severe left ventricular dysfunction defined by left ventricular ejection fraction (LVEF) \< 30%. * Severe right ventricular dysfunction defined by TAPSE \< 12 mm. * Cardiac arrhythmia or atrial fibrillation. * Abdominal compartment syndrome. * Amputation of one or both lower limbs. * Intracranial hypertension. * Pregnant women (ruled out by systematic pregnancy test at ICU admission). * Minors.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fluid responsiveness | T0 : baseline T1 : 60 to 90 after passive legs raising manoeuver or mini fluid challenge T2 : within 10 mins after fluid infusion of 500mL of crystalloïds solution | Echocardiographic measurement of subaortic velocity time integral (AoVTI) in apical 5-chambers view is performed before (T0 = Baseline) and within 10 mins (T2) after fluid administration. An increase of 15% or more of AoVTI after fluid administration of 500mL of a crystalloids solution compared to baseline define fluid responsiveness. |
| Ability of sub-pulmonary VTI variation to predict fluid responsiveness | T0 : Baseline T1 : 60 to 90 after passive legs raising manoeuver or mini fluid challenge T2 : within 10 mins after fluid infusion of 500mL of crystalloïds solution | The sub-pulmonary VTI variation (in %) between T0 and T1 is mesured with echocardiography from a transthoracic view (short axis parasternal and sub costal views depending of patient's echogenicity) Sub-pulmonary VTI variation ability to detect fluid responsiveness is assessed by constructing ROC curves to detect the best cut-off. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sub-pulmonary VTI values description | T0 : baseline T1 : 60 to 90 after passive legs raising manoeuver or mini fluid challenge T2 : within 10 mins after fluid infusion of 500mL of crystalloïds solution | To describe values of Sub-pulmonary VTI (cm) during the time frame measured with echocardiography in subcostal view and / or in parasternal short axis view depending of patient's echogenicity. |
Countries
France
Outcome results
None listed