Evaluation of the Association Between Right Atrial Reservoir Strain Variation and Fluid Responsiveness in Patients With Septic Shock

Launched by CENTRE HOSPITALIER UNIVERSITAIRE, AMIENS · Jul 1, 2024

Keywords

ClinConnect Summary

This clinical trial is studying how well a specific measurement called right atrial reservoir strain (RAS) can help doctors determine if patients with septic shock will respond positively to fluid treatments. Septic shock is a serious condition where the body goes into shock due to an infection, often requiring fluids to help support blood pressure. The trial aims to see if changes in RAS can identify patients who will benefit from additional fluids after a test called a fluid challenge, which checks if their heart can pump more blood after receiving fluids.

To participate in this study, patients need to be adults over 18 years old who are currently hospitalized in the Intensive Care Unit with septic shock for less than 48 hours. They also need to be receiving fluid treatments and on a specific type of breathing support. Participants will undergo tests that involve echocardiography, a safe and non-invasive way to look at the heart's function. It’s important to note that certain patients, such as those with severe heart issues or certain medical conditions, may not be eligible to join. Overall, this trial will help improve how doctors manage fluid treatments in critically ill patients, ensuring they receive the right amount of fluids for their condition.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Adult patient (\>18 years old)
• • Patient hospitalized in the Intensive Care Unit at Amiens University Hospital with septic shock for less than 48 hours, defined by the presence of all the following criteria: presence of sepsis, hypotension requiring vasopressors to maintain a mean arterial pressure ≥ 65 mmHg despite adequate prior fluid resuscitation, and blood lactate levels \> 2 mmol/l (18 mg/dl).
• • Patient requiring fluid resuscitation with crystalloids/colloids
• • Patient on invasive mechanical ventilation in assisted-controlled mode.
• • Blood pressure monitored via a radial or femoral arterial catheter connected to a MostCareUp (Vygon, France).
• • Patient or family informed and non-opposition documented.
• Exclusion Criteria:
• • Poor echocardiographic image quality preventing RASr assessment
• • Patient with a contraindication to the PLR maneuver: severe head trauma or intracranial hypertension
• • Patient with a history of pericardiectomy
• • Patient with a clinical examination consistent with abdominal compartment syndrome
• • Patient with aortic pathology, mitral regurgitation greater than grade 2, tricuspid regurgitation greater than grade 2, mitral stenosis, or intracardiac shunt
• • Patient with internal or external atrial/ventricular pacing
• • Pregnant woman
• • Patient on extracorporeal membrane oxygenation and mechanical circulatory support
• • Moribund patient
• • Patient with supraventricular or ventricular arrhythmia during echocardiographic measurement series
• • Patient on renal replacement therapy during echocardiographic examination