Evaluating Fluid Responsiveness in ICU Patients Using VTI and Trendelenburg Positioning

Launched by LENOX HILL HOSPITAL · May 13, 2024

Keywords

ClinConnect Summary

This clinical trial is studying how to better predict which critically ill patients in the ICU will benefit from receiving extra fluids. Sometimes, giving fluids can help, but it can also cause problems like too much fluid in the body. The researchers are looking at two methods: using something called velocity time integral (VTI), which helps measure blood flow, and placing patients in a position called Trendelenburg, where they lie back with their legs elevated. By doing this, they hope to identify patients who are more likely to respond positively to fluid therapy.

To participate in the trial, patients must be adults aged 18 or older who are in the medical or surgical ICU and need fluid treatment due to signs like low blood pressure, fast heart rate, or low urine output. However, patients who are pregnant, unable to safely lie in the Trendelenburg position, or have certain heart issues may not be eligible. If someone joins the study, they can expect to undergo evaluations that will help determine their response to fluids, contributing to better care for themselves and future patients.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Adult patients (≥ 18 years old) admitted to the medical or surgical ICU.
• • Patients who require fluid administration for suspicion of hypovolemia or indicated for volume expansion due to any one of the following: hypotension (systolic blood pressure \< 90 mm Hg or mean arterial pressure \< 65 mm Hg), tachycardia (heart rate \> 100 beats per min), blood lactate \> 2.0 mmol/L, skin mottling, oliguria (urine output \< 30 ml/hr), or requiring vasopressor/inotrope support.
• • Patients who are able to tolerate the Trendelenburg position.
• Exclusion Criteria:
• • Pregnancy.
• • Prisoners and institutionalized patients.
• • Patients who are not able to tolerate the Trendelenburg position. This includes patients with increased intra-cranial hypertension, intra-abdominal hypertension and gastric retention which places a risk for stomach fluid aspiration.
• • Unsatisfactory cardiac echogenicity (an inability to correctly align the Doppler beam to generate reliable VTI measurements at the left ventricular outflow tract \[LVOT\]).

Trial Officials