Prediction of Intradialytic Hypotension at the Initiation of Continuous Venovenous Hemodiafiltration Using Multimodal Ultrasonographic and Hemodynamic Parameters in Intensive Care Unit Patients
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 80
- 主要终点
- Hemodynamic Instability During CVVHDF Initiation
研究概览
简要总结
This prospective observational study aims to evaluate the ability of transthoracic echocardiographic and bedside ultrasonographic parameters to predict intradialytic hypotension and hemodynamic instability at the initiation of continuous venovenous hemodiafiltration (CVVHDF) in adult intensive care unit patients.
详细描述
In critically ill patients requiring renal replacement therapy, continuous venovenous hemodiafiltration (CVVHDF) is frequently preferred due to better hemodynamic tolerance. However, initiation of CVVHDF may still lead to unpredictable intradialytic hypotension, fluid requirement, or vasopressor/inotrope support.
Bedside transthoracic echocardiography and ultrasonography provide non-invasive assessment of cardiac function, preload responsiveness, and venous congestion. Parameters such as left ventricular outflow tract velocity time integral (LVOT VTI), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), pulse pressure variation (PPV), renal resistive index (RRI), inferior vena cava (IVC) diameter, and venous excess ultrasound score (VExUS) may help predict hemodynamic tolerance to dialysis.
This study aims to evaluate the predictive value of these multimodal ultrasonographic and hemodynamic parameters for intradialytic hypotension and hemodynamic support requirement during the first 60 minutes of CVVHDF initiation.
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 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients (≥18 years) admitted to the intensive care unit
- •Indication for continuous venovenous hemodiafiltration
- •Adequate transthoracic echocardiographic image quality
- •Written informed consent obtained from legal representatives
排除标准
- •Acute coronary syndrome
- •Severe valvular heart disease or pericardial effusion
- •Significant arrhythmias interfering with Doppler measurements
- •Presence of pacemaker, ICD, or ventricular assist device
- •Poor echocardiographic imaging window
- •Life expectancy less than 24 hours
结局指标
主要结局
Hemodynamic Instability During CVVHDF Initiation
时间窗: First 60 minutes after CVVHDF initiation
Occurrence of hypotension (mean arterial pressure \<65 mmHg), requirement for fluid bolus (≥500 mL), or initiation/increase of vasopressor or inotrope support within the first 60 minutes after CVVHDF initiation.
次要结局
- LVOT Velocity Time Integral(Before CVVHDF initiation)
- Mitral Annular Plane Systolic Excursion (MAPSE)(Before CVVHDF initiation)
- Tricuspid Annular Plane Systolic Excursion (TAPSE)(Before CVVHDF initiation)
- Pulse Pressure Variation (PPV)(Before CVVHDF initiation)
- Renal Resistive Index (RRI)(Before CVVHDF initiation)
- Inferior Vena Cava Diameter(Before CVVHDF initiation)
- Venous Excess Ultrasound Score (VExUS)(Before CVVHDF initiation)
研究者
Musa Harun UÇAR
Specialist in Anesthesiology and Reanimation
Kanuni Sultan Suleyman Training and Research Hospital