Critical Illness, Intradialytic Hypotension, Renal Failure , Chronic
Conditions
Keywords
Intradialytic Hypotension, LVOT VTI, CVVHD, Renal Resistive Index, Echocardiography, VExUS
Brief summary
This prospective observational study aims to evaluate the ability of transthoracic echocardiographic and bedside ultrasonographic parameters to predict intradialytic hypotension and hemodynamic instability at the initiation of continuous venovenous hemodiafiltration (CVVHDF) in adult intensive care unit patients.
Detailed description
In critically ill patients requiring renal replacement therapy, continuous venovenous hemodiafiltration (CVVHDF) is frequently preferred due to better hemodynamic tolerance. However, initiation of CVVHDF may still lead to unpredictable intradialytic hypotension, fluid requirement, or vasopressor/inotrope support. Bedside transthoracic echocardiography and ultrasonography provide non-invasive assessment of cardiac function, preload responsiveness, and venous congestion. Parameters such as left ventricular outflow tract velocity time integral (LVOT VTI), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), pulse pressure variation (PPV), renal resistive index (RRI), inferior vena cava (IVC) diameter, and venous excess ultrasound score (VExUS) may help predict hemodynamic tolerance to dialysis. This study aims to evaluate the predictive value of these multimodal ultrasonographic and hemodynamic parameters for intradialytic hypotension and hemodynamic support requirement during the first 60 minutes of CVVHDF initiation.
Interventions
None listed
Sponsors
Bursa Yuksek Ihtisas Training and Research Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients (≥18 years) admitted to the intensive care unit * Indication for continuous venovenous hemodiafiltration * Adequate transthoracic echocardiographic image quality * Written informed consent obtained from legal representatives
Exclusion criteria
* Acute coronary syndrome * Severe valvular heart disease or pericardial effusion * Significant arrhythmias interfering with Doppler measurements * Presence of pacemaker, ICD, or ventricular assist device * Poor echocardiographic imaging window * Life expectancy less than 24 hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic Instability During CVVHDF Initiation | First 60 minutes after CVVHDF initiation | Occurrence of hypotension (mean arterial pressure \<65 mmHg), requirement for fluid bolus (≥500 mL), or initiation/increase of vasopressor or inotrope support within the first 60 minutes after CVVHDF initiation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| LVOT Velocity Time Integral | Before CVVHDF initiation | Measurement of left ventricular outflow tract velocity time integral obtained by transthoracic echocardiography before dialysis initiation. |
| Mitral Annular Plane Systolic Excursion (MAPSE) | Before CVVHDF initiation | Measurement of mitral annular plane systolic excursion obtained by M-mode transthoracic echocardiography in the apical four-chamber view to assess left ventricular longitudinal systolic function prior to CVVHDF initiation. |
| Tricuspid Annular Plane Systolic Excursion (TAPSE) | Before CVVHDF initiation | Measurement of tricuspid annular plane systolic excursion obtained by M-mode transthoracic echocardiography in the apical four-chamber view to evaluate right ventricular systolic function prior to CVVHDF initiation. |
| Pulse Pressure Variation (PPV) | Before CVVHDF initiation | Calculation of pulse pressure variation derived from invasive arterial blood pressure waveform analysis in mechanically ventilated patients to assess dynamic preload responsiveness prior to CVVHDF initiation. |
| Renal Resistive Index (RRI) | Before CVVHDF initiation | Measurement of the Renal Resistive Index (RRI), obtained by pulsed-wave Doppler ultrasonography of the segmental or interlobar renal arteries, to evaluate intrarenal vascular resistance and renal perfusion prior to initiation of continuous veno-venous hemodiafiltration (CVVHDF). The Renal Resistive Index is calculated as (peak systolic velocity - end diastolic velocity) / peak systolic velocity, with values ranging from 0 to 1. Values greater than 0.7 are considered indicative of increased intrarenal vascular resistance and poorer renal perfusion (worse outcome). |
| Inferior Vena Cava Diameter | Before CVVHDF initiation | Ultrasonographic measurement of inferior vena cava diameter obtained from the subcostal long-axis view to assess intravascular volume status prior to CVVHDF initiation. |
| Venous Excess Ultrasound Score (VExUS) | Before CVVHDF initiation | Assessment of systemic venous congestion using the Venous Excess Ultrasound Score (VExUS) prior to initiation of continuous veno-venous hemodiafiltration (CVVHDF). The Venous Excess Ultrasound Score is a grading system ranging from 0 to 3, incorporating inferior vena cava diameter and Doppler flow patterns of the hepatic, portal, and intrarenal veins. Higher scores indicate more severe systemic venous congestion and are associated with worse clinical status. |
Contacts
CONTACTmusa h UÇAR
Outcome results
None listed