The role of Femoral vein Pulsatility in the prediction of Acute Kidney Injury in patients with peritonitis and Abdominal sepsis: A prospective observational study

At the bedside, in patients with poorly accessible thoracic and abdominal wall examination after sternotomy, thoracotomy, or laparotomy; transthoracic echocardiographic (TTE) and VEXUS examinations might be challenging because of suboptimal echogenicity, due to unfavourable anatomy and sometimes, positive pressure ventilation. In such patients, the femoral vein Doppler ultrasound examination is feasible and has correlated well with venous congestion in the critically ill population. The study aims to determine the association between the presence of a pulsatile femoral vein and acute kidney injury in patients with complicated intra-abdominal infections and abdominal sepsis.

Methodology:

Baseline demographic details will be obtainedfrom medical records. The patients will be evaluated at baseline (within 24 hours of admission to ICU: Day 1 ), on Day 3( within 72 hrs of admission) and on Day 5. For each time point, the hemodynamic, respiratory and cardiac ultrasound parameters will be noted.USG examination for femoral vein pulsatility will be done by a trained intensivist with more than 5 years’ of experience in bedside ultrasound. All images will be reviewed and confirmed by another intensivist with extensive bedside ultrasound experience.

Measurement of Femoral Vein Pulsatility: Ultrasound assessment will be performed bedside in the supine position using a linear array probe. Common femoral vein will be identified 2–3 cm below the inguinal ligament and it will be examined in both short and long axis with angle correction within 60°. Normal Femoral Vein Doppler (FVD) will be defined as antegrade mildly pulsatile uninterrupted pattern with respiratory variation and retrograde flow of less than 1/3rd of antegrade flow. FVD will be considered significant or suggestive of venous congestion if either of the criteria  is fulfilled. Pulsatile in nature 2. Retrograde flow velocity of more than 10 cm/s 3. Retrograde flow velocity is more than 1/3rd of antegrade flow velocity (flow reversal)

Outcome measures: The value for baseline serum creatinine will be determined in a hierarchical approach. The lowest serum creatinine between 12 months and 24 h before hospital admission will be used when available. If no such creatinine value is available, the lowest creatinine value between 24 hours prior to hospital admission and the time of ICU admission will be used.