Evaluation of fluid overload in Septic patients admitted to intensive care unit with Combined Venous Excess Lung Ultrasound (VExLUS) Score
Overview
- Phase
- Not Applicable
- Status
- Recruiting
- Sponsor
- All India Institute of Medical Sciences Patna
- Enrollment
- 93
- Locations
- 1
- Primary Endpoint
- Incidence of global fluid overload by measuring VExLUS score
Overview
Brief Summary
Hemodynamic management in critically ill septic patients has been traditionally focused on maintaining adequate cardiac output and arterial blood pressure by relying on fluid administration along with vasopressor and inotropic support. However, administration of fluid may lead to venous congestion compromising the organ perfusion which can be overlooked as a hemodynamic parameter on clinical assessment, and could be of utmost importance in management. Point of care ultrasound (POCUS) at bedside allows the clinician to assess the status of intravascular volume and rule out portal, intrarenal and pulmonary fluid overload. The correlation of modified lung ultrasound score and extravascular fluid is a well-known parameter for the assessment of the global fluid status of the patient. Adding a lung ultrasound score to VExUS grading is a novel concept. Lung ultrasound evaluates 6 different lung areas,looking at B lines and graded 0,1,2,3. VExUS protocol evaluates the amount of venous congestion in the abdominal organs, specifically by scanning the portal, hepatic, and intra-renal veins. Doppler interrogation of these vessels yields a specific pattern corresponding to a level of venous congestion: normal, mild, or severe. By combining modified lung ultrasound score and VExUS grading, might lead to improvement in the sensitivity of early fluid overload detection.This is a kind of study to evaluate the VExLUS grades in earlier identification of fluid overload in septic patients.
Study Design
- Study Type
- Observational
Eligibility Criteria
- Ages
- 18.00 Year(s) to 65.00 Year(s) (—)
- Sex
- All
Inclusion Criteria
- •Diagnosis of sepsis (consistent with surviving sepsis campaign guidelines 2021 and clinical indication to be admitted in ICU).
Exclusion Criteria
- •Patients in hemodialysis program Patients with previously known conditions that interfere with portal Doppler assessments, namely liver cirrhosis, or severe tricuspid regurgitation with structural heart disease.
- •If any of these conditions are identified during the present episode, the patient would also be excluded.
- •Age less than 18 years Patients subjected to withdrawal of care Hemodynamic instability due to active hemorrhage Acute coronary syndrome Indication for immediate surgery Received CPR within 24 hours of enrollment Pregnancy.
Outcomes
Primary Outcomes
Incidence of global fluid overload by measuring VExLUS score
Time Frame: 0-12hrs | 24-36hrs | 48-72hrs | Discharge time
Secondary Outcomes
- To asses correlation between VexLUS score and cumulative fluid balance(0-12hrs)
- To asses correlation between VexLUS score and acute kidney injury(0-12hrs)
- To asses correlation between VexLUS score and ICU length stay(0-12hrs)
- To asses correlation between VexLUS score and congestive respiratory failure(not attributed to other causes)(0-12hrs)
- Proportion of the need for diuretic use or Renal Replacement therapy to correct fluid overload(0-12hrs)
- To predict 28 day mortality on VexLUS score(0-12hrs)
Investigators
Dr D Prithvi
AIIMS Patna