Critically ill patients Circulatory shock Fluid de-escalation VExUS Fluid de-escalation Fluid removal Tolerance
Conditions
Interventions
Critically ill patients with a history of circulatory shock undergoing fluid de-escalation
Diagnostic
Sponsors
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Eligibility
Sex/Gender
All
Age
18 Years to 100 Years
Inclusion criteria
Inclusion criteria: 1. Adult patients (age 18 years and over) admitted in intensive care units (both medical and surgical ICU) of Ramathibodi Hospital 2. Presence of fluid accumulation, defined as positive fluid balance 10% or more of body weight 3. Hemodynamic stability, defined as a. Adequate tissue perfusion (capillary refilling time less than 3 seconds) b. Mean arterial pressure more than 65 mmHg with i. Clearing decreasing dose of vasopressor ii. Norepinephrine less than 0.2 mcg/kg/min iii. Arterial lactate level less than 2 mmol/L 4. Need for fluid de-escalation, as decided by the attending physicians
Exclusion criteria
Exclusion criteria: 1. Patients who refused to participate in the study or withdraw from the study 2. Patients who had severe chronic kidney disease (estimated glomerular filtration rate less than 15 mL/min per 1.73 m2 or in regular dialysis program) or renal transplantation 3. Patients with obstacles to abdominal ultrasound include severe obesity (BMI of 40 or higher), having had abdominal surgery or having abdominal burn wounds in the positions that may impede ultrasound. 4. Patients with previously known conditions that interfere with portal Doppler assessments (liver cirrhosis, portal vein thrombosis, or severe tricuspid regurgitation with structural heart disease) 5. Pregnancy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Ability of VExUS grading 6 and 24 hours after fluid de-escalation hypotension, AKI | — |
Secondary
| Measure | Time frame |
|---|---|
| VExUS grade 6 and 24 hours after fluid de-escalation Change in grade of VExUS | — |
Countries
Thailand
Contacts
Public ContactKanyanat Klinhomsophon
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Outcome results
None listed