Echocardiographic Left Ventricular End Diastolic Area Versus Carotid Artery Duplex as a Sensitive Indicator for Guiding Fluid Resuscitation in Septic Shock Patients . A Prospective Cohort Study
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 40
- 试验地点
- 1
- 主要终点
- Accuracy of echo and ultrasound indices
研究概览
简要总结
Fluid replacement is considered the cornerstone of hemodynamic management in critically ill patients especially in patients with septic shock. However, only about 50% of critically ill hemodynamically unstable patients are responsive to fluids. Consequently, the resuscitation of critically ill patients requires an accurate assessment of the patients' intravascular volume status and their volume responsiveness. In this study, we will compare the efficacy of carotid artery flow to echo left ventricular end diastolic volume as a predictive value for fluid resuscitation in septic shock patients.
详细描述
Fluid replacement is considered the cornerstone of hemodynamic management in critically ill patients especially in patients with septic shock. However, only about 50% of critically ill hemodynamically unstable patients are responsive to fluids. Consequently, the resuscitation of critically ill patients requires an accurate assessment of the patients' intravascular volume status and their volume responsiveness. In this study, we will compare the efficacy of carotid artery flow to echo left ventricular end diastolic volume as a predictive value for fluid resuscitation in septic shock patients.The Doppler study of carotid artery circulation (Velocity Time Integral, Peak Velocity) is simple and overpasses this common limitation among intensive care patients. Moreover, it showed to be an easy-learning tool The Velocity Time Integral (VTI) is a measurement of blood flow during systole that is passing through the left ventricular outflow tract (LVOT). The normal range for a VTI is 18-22 cm, values below this are suggestive of depressed cardiac output, an increase in the VTI is indicative of an increase in cardiac output. If a significant change in VTI 15% or more VTI0is observed after a fluid challenge, this would indicate that the patient is preload (fluid) responsive.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 50 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •▪ Age:18-50 years old
- •Sex: both males &females.
- •Patients diagnosed with septic shock according to SOFA score more than or equal 1
- •Presence of at least one sign of acute circulatory failure from:
- •Low blood pressure (mean arterial pressure <65 mmHg and / or systolic <90 mmHg).
- •Tachycardia> 120 bpm without other obvious cause of circulatory failure.
- •Oliguria <1 ml / kg during the last hour suggestive of circulatory failure.
- •Blood hyperlactatemia > 2mmol / l without other obvious cause a systemic circulatory failure.
- •Another sign justifying, for example vascular increase capillary refill time more than 2 seconds.
排除标准
- •▪ Known significant valvular heart disease (sever aortic insufficiency or stenosis)
- •Known carotid artery stenosis >50% or previous carotid surgery
- •Clear contraindication to the carotid artery Doppler such as wound or infection or complete or partial occlusion of the carotid artery.
- •Arrhythmias affect stroke volume assessment (atrial fibrillation, frequent PVCs)
- •Dilated cardiomyopathy.
- •Poor transthoracic echocardiographic window
- •Patient refusal
研究组 & 干预措施
septic shock patients
septic shock according to SOFA score more than or equal 1
干预措施: carotid artery duplex (Procedure)
septic shock patients
septic shock according to SOFA score more than or equal 1
干预措施: Left ventricular end diastolic area (Procedure)
结局指标
主要结局
Accuracy of echo and ultrasound indices
时间窗: 1 Day
Diagnostic accuracy (sensitivity, specificity) of LVEDA and carotid artery flow parameters (PEAK Systolic Velocity, Velocity time integral (VTI), in predicting fluid responsiveness defined as an increase in stroke volume after a standardized fluid challenge.
次要结局
未报告次要终点