Correlation between Corrected Carotid Flow Time and Left Ventricular Outflow Tract Velocity-Time Integral using Trans-Thoracic Echocardiography for assessing Fluid Responsiveness in septic shock patients admitted to ICU : A Prospective observational Study
Overview
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- AIIMS PATNA
- Enrollment
- 52
- Locations
- 1
- Primary Endpoint
- LVOT-VTI
Overview
Brief Summary
Selecting an efficient method to assess Fluid responsiveness in ICU is crucial
especially in first one hour of presentation in septic shock patients. Prompt
administration of fluid during early resuscitation phase might prove to be an important
factor in further prognosis of the patient. According to Recent Surviving Sepsis
Guidelines, the second pillar of treatment is fluid resuscitation.
Rationale
Trans-Thoracic Echocardiography (TTE) is widely used in ICU for assessing fluid
responsiveness. The left ventricular outflow tract velocity time integral (LVOT VTI)
shows how the SV changes in response to fluid administration; therefore, the LVOT
VTI is used to guide intravenous fluid management. However, Common Carotid
Artery Flow Doppler is much easier, does not depend on adequate cardiac windows,
and requires less skill and expertise than LVOT VTI.
Study Procedure
Transthoracic Echocardiography will be done to assess LVOT VTI initially and 20 minutes after fluid administration. Corrected Carotid Flow Time (cCFT) will also be calculated similarly at these two time points. Fluid responsiveness will be defined if LVOT VTI is more than 17 cm or Delta VTI is less than 15 percent, and corresponding cCFT value will be taken for correlation with LVOT VTI
Study Design
- Study Type
- Observational
Eligibility Criteria
- Ages
- 18.00 Year(s) to 85.00 Year(s) (—)
- Sex
- All
Inclusion Criteria
- •Patients in Septic Shock as per recent surviving sepsis guidelines (SSG 2021).
Exclusion Criteria
- •Age less than 18 and more than
- •Poor quality of ultrasonographic imaging.
- •Inability to achieve a zero degree angulation of the pulsed Doppler signal for assessing LVOT or carotid flow, LVOT dynamic obstruction, cardiac arrhythmia.
- •Significant aortic valve disease (stenosis and/or moderate to severe insufficiency) significant carotid disease (stenosis greater than 50%) Intracranial hypertension cerebral circulatory arrest, aortic dissection, ischemic heart disease, heart failure, and hypertensive crisis requiring vasoactive drugs.
Outcomes
Primary Outcomes
LVOT-VTI
Time Frame: Baseline and after 20 minutes of Fluid Administration
Corrected Carotid Flow Time
Time Frame: Baseline and after 20 minutes of Fluid Administration
Delta VTI
Time Frame: Baseline and after 20 minutes of Fluid Administration
Stroke volume variation
Time Frame: Baseline and after 20 minutes of Fluid Administration
Secondary Outcomes
- Duration on Mechanical Ventilator(Duration on Ionotropic Support)
Investigators
Mainak Baidya
AIIMS PATNA